Pinetree Lodge

We found the following examples of good practice.

¿ Systems were in place to help prevent people, staff and visitors from catching and spreading infection.

¿ There was enough PPE such as aprons, gloves and masks, which staff were seen to use. Staff had undertaken training in putting on and taking off PPE and the registered manager had checked staff compliance with the guidance. They were routinely checking and were in the process of doing spot checks. This was designed to reduce the potential for staff to become complacent when working with people.

¿ Staff and people were tested regularly for COVID-19. A COVID-19 vaccination programme was in place.

¿ People who used the service spoke positively about how the staff had supported them. The registered manager explained how they and practice development lead worked with the senior management, people and visitors to implement the change to the visiting policy. The first indoor visit started this week. Relatives, previously, had been able to have window and pod visits as well as to speak with people via face-time calls.

¿We observed positive interactions between staff and people. One person told us, "The staff do a good job, and know their stuff. It is good you come to check they are up to muster, I find they are."

Further information is in the detailed findings below.

Pinetree Lodge is a residential care home providing personal and nursing care to 20 people at the time of the inspection. The service can support up to 34 people.

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

The provider had systems in place to ensure people were protected from abuse and harm.

Risks to people were not always recognised. The service had introduced a new risk assessment tool to address this, but it was too early to see how successful it was. The service did not ensure it had appropriate documentation for the recording of administering topical creams and patches that held medicine. The provider’s quality assurance systems did not identify the issues we found during inspection. The registered manager was proactive and ensured all issues were addressed on the first day of the inspection.

Systems were in place to make sure people remained safe in the event of an emergency. The provider carried out checks to maintain the safety of equipment and the home.

Sufficient well-trained and experienced staff were available to ensure people’s needs were met. Staff promoted hydration and supported people to maintain a balanced diet. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Staff clearly knew people well. The service had developed positive partnerships with healthcare professionals involved in the service. One healthcare professional we spoke with was complimentary about the end of life care.

People and relatives told us staff were kind and caring. Staff were respectful to people and supported people to maintain their dignity.

Staff supported people to take part in a range of activities and access the local community. Healthcare professionals were complimentary about the delivery of person-centred care. People and relatives told us they had no complaints about the service.

Staff we spoke with told us they were supported by the provider and were encouraged to develop their skills and knowledge. The service was creative in the delivery of training.

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

Rating at last inspection

The last rating for this service was Good (published 7 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor this service and inspect in line with our re-inspection schedule for services rated good. If we receive any concerning information we may inspect sooner.

Pinetree Lodge is a care home providing accommodation and nursing care for up to 34 adults. Care is provided to people living with dementia. Accommodation is across one floor divided into two separate units. At the time of our inspection there were 27 people living at the home.

The service had a registered manager. 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.

Although there were sufficient staff to meet people’s needs the provider was not using a dependency tool to support the setting of staffing levels. We made a recommendation about this.

The service managed medicines appropriately. They were correctly stored, monitored and administered in accordance with the prescription. People were supported to maintain their health and to access health services if needed. People who required support with eating and drinking received it and had their nutrition and hydration support needs regularly assessed.

Staff were trained to an appropriate standard and received regular supervision and appraisal. As part of their recruitment process the service carried out background checks on new staff.

Where people were not able to make important decisions about their lives the principles of the Mental Capacity Act 2005 were followed to protect their rights. Staff were aware of how to identify and report abuse. There were also policies in place that outlined what to do if staff had concerns about the practice of a colleague.

Care plans were subject to regular review to ensure they met people’s changing needs. They were easy to read and based on assessment and reflected the needs of people. Risk assessments were carried out and plans were put in place to reduce risks to people’ safety and welfare.

Staff had developed good relationships with people and communicated in a kind and friendly manner. They were aware of how to treat people with dignity and respect. Policies were in place that outlined acceptable standards in this area.

There was a complaints procedure in place that outlined how to make a complaint and how long it would take to deal with. People were aware of how to raise a complaint and who to speak with about any concerns they had. There were no outstanding complaints in the service.

The home was well led by a registered manager who had a vision for the future of the service. A quality assurance system was in place that was utilised to improve the service.

We undertook this focused inspection to check that the provider had followed their plan and to confirm whether they now met legal requirements. This report only covers our findings in relation to these requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Pinetree Lodge on our website at www.cqc.org.uk.

Pinetree Lodge is a care home providing accommodation and nursing care for up to 34 adults. Care is provided to people living with dementia. Accommodation is provided on one floor.

The service had a 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.

We found action had been taken to ensure appropriate arrangements were in place in relation to the recording of medicines. There was a process for regularly monitoring these records to check that they were completed properly. Records for the application of creams and ointments by care staff were not fully completed and required further improvement.

Arrangement for training staff in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards, as well as providing dementia awareness, had been improved. Staff had commenced training on these topics and further sessions and access to internet based learning was planned.

We found the provider had met the assurances they had given in their action plan.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found.

Is the service safe?

Relatives we spoke with told us they were confident that their family members were safe at the home. We found safeguarding procedures were robust and staff understood how to safeguard the people they supported. One relative told us, 'I have no concerns about his welfare or safety here.' Another relative said, 'He is well looked after and I have no concerns whatsoever, he's safe here.'

People were cared for in an environment that was safe, clean and hygienic. Equipment at the home had been well maintained and serviced regularly, therefore not putting people at unnecessary risk. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies. The building was clean, well maintained and secure and other appropriate measures were in place to ensure the security of the premises. One relative told us, "They have good staff who deal with and handle people very well. We as a family are happy and think he gets good care.'

Is the service effective?

People told us that they were happy with the care that was delivered and their needs were met. It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well. We looked at how staff were supported to deliver care and treatment safely and to an appropriate standard. Staff had received training to meet the needs of the people living at the home. One relative told us, "The care, support and the treatment is good. I have no complaints whatsoever and that is down to the staff; the staff are smashing.' Another relative said, 'He needed a special mattress for when came out of hospital. They arranged the physiotherapist and sorted everything for him when he came back here.'

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. One relative told us, 'They seem to understand dementia and mental health conditions. The care and treatment is great.' Other relative's comments included, 'The staff are like your own family, friendly and caring,' and, 'They are so caring with him.'

Is the service responsive?

Care records for people at the service were reviewed monthly to make sure that the information was accurate and up to date. Where people's needs had changed, their care plans were updated more frequently. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support was provided in accordance with people's wishes.

We saw the provider had a written complaints policy and procedure, which detailed the process that should be followed in the event of a complaint. The registered manager told us, and records confirmed that no complaints had been received by the service within the 12 months. We also noted that 10 compliments had been received by the service within the last 12 months.

We saw the service had policies and procedures in place in relation to the safeguarding of adults and Deprivation of Liberty Safeguards. We noted the registered manager had recently made Deprivation of Liberty safeguards applications to the local authority. This meant that people were safeguarded as required and the provider responded appropriately to any potential allegations of abuse.

Is the service well-led?

The service had a registered manager who had been in post since April 2012 and the provider had in place systems to monitor the quality of the service people received.

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. People and their relatives were able to complete a customer satisfaction survey. Staff told us they were clear about their roles and responsibilities. This helped to ensure that people received a good quality service at all times. The provider undertook regular audits and risk assessments to monitor the quality of the services and there were effective systems to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

Both staff, people who used the service and their relatives said communication was good. One relative told us, 'I find Wendy (registered manager) very helpful and friendly. The home seems to be very well run.'

Staff received regular supervision and appraisal and told us they felt supported by the management team. A member of the management team was available on call for advice and support and in case of emergencies.

During this inspection we found that improvements had been made to protect people against the risks associated with the management of medicines, and the action plan had addressed the concerns we had previously identified.

During this inspection we checked people were getting the medicines that they needed by looking at their medication records and the storage of medicines. We did not speak to people who used the service on this visit.

We found people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

Some people who used the service had complex needs which meant they could not share their experiences. We used a number of methods to help us understand their experiences, including carrying out an observation and speaking with visiting relatives.

During our observation we saw people were treated with consideration and respect. Relatives told us they were happy with the care which was provided. One relative said, "The staff are really on top of their game here. They react very quickly if things aren't right. I have no worries I know if my husband isn't well they'll get the doctor or take him to hospital. They are very good."

We reviewed four care records and saw that people's preferences and care needs had been well documented. Staff were knowledgeable about the people's care needs and what they should do to support them.

Staff training was kept up to date so that staff could care for people safely and to an appropriate standard.

However people were not protected against the risks associated with medicines because medicine records had not been accurately maintained and arrangements in place to obtain medicines were not robust.

Care and treatment was planned in a way that ensured people's safety and welfare. We saw care plans had been re-written since our last inspection and were now more specific and detailed. One family member said 'I would recommend it to anyone. I think it's marvellous, I can't fault it. I work in care so I know what to look for and everything is great. I don't worry about my dad anymore. I can sleep at night. It's a weight off my mind knowing he's being well looked after.' Another family member said, 'Pinetree Lodge is a good home. No matter who you speak to and I know a lot of people who know of the home, everyone only has praise for it.'

We found that appropriate checks were in place to make sure people continued to receive appropriate and safe care. We also found that each person's care records had been audited since our last inspection.

We found the quality of records had improved and most documents were named and dated with accurate entries made. This meant records were clear and easier to follow to ensure that people received appropriate and safe care.

However during our observation, carried out during a mealtime, we found that people were not always treated with consideration and respect. We also found the environment had not been adapted to help people to find their way around, and personal items had been left on display in bathrooms and toilets which did not promote people's dignity.

Relatives told us people were well taken care of. One relative said, 'The care is excellent.' Another relative told us, '(My relative) has been poorly a few times, and staff have got a doctor straight away. No hesitation.'

However we found shortfalls in the planning and provision of care.

We found significant gaps in staff training, and that care records were inaccurate.