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Inspection carried out on 18 January 2017

During a routine inspection

We carried out an unannounced comprehensive inspection on 18 and 30 January 2017. Pinewood Nursing Home provides accommodation for up to 33 people who need support with their personal care. The home provides support for older people requiring nursing care and for some people who are living with dementia. The home is a large, converted period property with sea views. Accommodation is arranged over four floors and there is a talking passenger lift to assist people to get to all floors. The home has 31 single bedrooms, with two which can be used as double rooms if two people choose to share. There were 28 people living at the home at the time of our inspection, two of these people were residential and had their nursing needs met by the community nurse team.

We had previously carried out a comprehensive inspection of this service in November 2014. A breach of a legal requirement had been found at that inspection. The breach was because there were not accurate records in relation to the care and treatment people were receiving. At this inspection we found action had been taken regarding these concerns and the requirement had been met.

The registered manager had left the service in December 2015 and has submitted their application to deregistered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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. A new manager was in post who had undertaken an induction period with the registered manager before they left. The manager had started the process to registered with the CQC to become the registered manager at the service. Staff were very positive about the new manager saying they were approachable and always available if they wanted to talk with them.

There were adequate staffing levels to meet people’s needs. The manager had made changes to the deployment of staff which staff said meant they could meet people’s needs more effectively. There were also two registered nurses on duty each morning which enabled improved record keeping. People felt there were adequate numbers of staff on duty and that staff responded to bells promptly.

People were supported by staff who had the required recruitment checks in place. Staff received an induction and were knowledgeable about the signs of abuse and how to report concerns. Staff had received training and developed skills and knowledge to meet people’s needs. Staff relationships with people were caring and supportive. They delivered care that was kind and compassionate.

Individual risks to people’s safety had been assessed and plans written to show how these were being addressed. The home had a contingency plan and had also developed individual personal evacuation plans to support each person.

Medicines were safely managed and procedures were in place to ensure people received their medicines as prescribed. Improvements were made during the inspection to ensure staff were clearly guided regarding the prescribed administration of topical creams.

Care plans were personalised and recognised people’s health and social needs. We raised concerns with the registered manager that care plans did not always cover people’s emotional and psychological needs. During the inspection the registered manager and deputy manager put in place care plans where needed to ensure all people’s emotional and psychological health needs were covered.

People’s views and suggestions were taken into account to improve the service. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

Staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. Where people lacked capacity, h

Inspection carried out on 26 and 27 November 2014

During a routine inspection

We undertook an unannounced inspection of Pinewood Nursing Home on 26th and 27th November 2014.

We last inspected Pinewood Nursing Home in December 2013. At that inspection we found the service was meeting all the essential standards that we assessed.

Pinewood Nursing Home provides accommodation for up to 33 people who need support with their personal care. The home provides support for older people requiring nursing care and for some people who are living with dementia. The home is a large, converted period property with sea views. Accommodation is arranged over four floors and there is a talking passenger lift to assist people to get to all floors. The home has 31 single bedrooms, with two which can be used as double rooms if two people choose to share. There were 31 people living at the home at the time of our inspection.

We observed care and support in communal areas, spoke to people in private, and looked at care and management records.

The service has 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. The registered manager was accessible and approachable. People who used the service said they felt able to speak with the registered manager and said they were an active part of the team. Staff said they felt well supported by the registered manager and the provider.

People’s needs and risks were assessed before admission to the home and these were reviewed on a regular basis. People and their families had discussed their care needs when they were admitted to the home. However care plans were not personalised to their individual needs. The care plans were pre-populated with standard information, and had very little, and in some cases, no additional person-centred information. However staff had a good understanding of how people wanted to be supported because long standing experienced staff had shared this information. Care plans were reviewed by the nurses at the home and people and their families were not asked their views.

People’s health care needs were well met. People were supported to receive treatment and health care advice and support.

People had access to activities at the home, however there was not an effective system to ensure all people had access to activities. This meant some people were at risk of not being included and becoming socially isolated.

People using the service said they felt safe. One person said “Safe and well looked after.” Staff understood how to protect people from abuse and the home had acted to protect people where they believed abuse or harm might have occurred. Examples included staff reporting bad practice and the registered provider reporting concerns to the relevant external agencies. Each person had risks to their wellbeing assessed and steps were taken to mitigate any known risk, such as falls or skin damage from pressure.

People received their medicines in a safe way because they were administered appropriately by suitably qualified staff and there were effective monitoring systems in place. The home had put into place a more robust system to ensure people had their prescribed creams administered safely and appropriately.

Staffing levels were set according to the needs of the people who used the service. Staff were caring and experienced and held relevant qualifications in health and social care.

Staff liaised with external healthcare professionals to get specialist advice and arrange the care and treatment they needed.

People could choose from a menu which was regularly reviewed and updated and took into account people’s choices and preferences.

Staff were polite and respectful when supporting people who used the service. Staff patiently helped people to eat their meals at their own pace. Staff supported people to maintain their dignity and were respectful of their privacy. People’s relatives and friends were able to visit without being unnecessarily restricted.

People knew how to raise concerns and make complaints. People told us concerns raised had been dealt with promptly and satisfactorily. Any complaints made were thoroughly investigated and recorded. Learning from incidents had occurred and been used to drive improvements.

The provider had an effective quality assurance system in place to monitor the effectiveness of the service.

Inspection carried out on 12 December 2013

During a routine inspection

When we visited Pinewood Nursing Home we spoke with five people who use the service, three relatives, the provider, the matron and three care staff. Comments about the service were positive.

Staff were observed to support people in a calm and respectful manner explaining to people what they were doing. Clear information was given to people by staff. People were appropriately assisted with mobility needs.

Staff confirmed that before people received any care or treatment they were asked for their consent. They said that their wishes were always respected. People we spoke with all agreed that they were consulted about their care and treatment daily.

We looked at peoples individual care plans and saw that the information recorded enabled staff to plan and deliver the required level of care and support on an individual basis.

Appropriate arrangements were in place in relation to obtaining, storage, administering and disposal of medicine.

We looked at the training plan for the service. We saw that the majority of staff had up to date training in all mandatory training including safeguarding, manual handling, infection control, first aid and fire safety. Staff told us that they had received regular training and that they felt that they were supported to carry out their roles and meet the needs of people who used the service.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

Inspection carried out on 4 March 2013

During a routine inspection

People received good quality support. People were encouraged to express their views and live as they wished. We saw that people had full and varied social lives.

People we spoke with told us that they were happy with their care and felt included in their plans. One person told us they “really like it here” and “I can't fault it”. One person told us they “like the view from my room” and “I get on with all the lovely staff”.

People and their families were encouraged in developing their care plans. We saw that care plans were person centred and reflected each person’s needs and preferences. People told us they were happy with the staff support they received.

Staff were knowledgeable about people’s support needs and treated people respectfully. They were supportive and patient. They explained and reassured people where necessary. Complaints and concerns were listened to and acted upon immediately.

Inspection carried out on 17 March and 9 June 2011

During a routine inspection

When we asked people living at the home what they thought of it, their comments included ‘Great’, and ‘I love it here. It’s nice, and the people are nice [staff and fellow residents]’. A care manager who supported people living at the home told us they had ‘everything positive to say about the nursing home’, as in their opinion it had a most responsive, professional team of staff who were very good communicators, honest, and flexible.

People felt listened to, and that they were given choices about their daily care. One person told us ‘They always ask you what you think.’ Music was playing in a lounge, and people there confirmed they had been asked about this.

Where people had mental capacity, their decisions were respected even when they were potentially putting themselves at risk of harm. Staff tried to help them make informed decisions. The relative of someone who had cognitive impairment told us that they were invited to the person’s next care plan review. Care records did not show how decisions about individuals’ lack of mental capacity had been reached, however.

Staff knocked on bedroom doors and paused before entering, which people living at the home told us was usual practice. They felt their dignity was upheld; one person added ‘The carers are so nice and patient. They have unpleasant jobs to do and they never seem to worry.’

Some people told us that church services were held regularly at the home, and that they had enjoyed the home’s recent fete, to which the local community had been invited. One person told us that the staff posted letters for them, so they could keep in touch with family and friends.

There was a care plan for each person. One person did not recall seeing theirs but said they were happy with the care they received, adding ‘There’s no rigid routine here.’ People did not have any concerns about the service’s handling of information about them.

Some people were cared for in bed during our visit. We noted that photos, flowers and other items were placed in their sight. They looked comfortable and as though their personal care needs had been attended to. A visitor told us that they always found their relative looking comfortable.

People with mobility needs confirmed that staff assisted them gently and didn’t rush them, with medication for pain given promptly if they requested it. They felt there were sufficient aids and adaptations to help them remain safely independent where possible.

They indicated that staff were watchful of their health, as did other people. Someone had an intermittent medical condition that required immediate attention at times, and they told us they received good support from staff at such times. Although people living at the home were satisfied with how staff managed their medications, we found there was not always sufficient information or guidance for staff to ensure they would manage people’s medicines appropriately.

People’s comments about the food included ‘Very good’, and ‘I get a good choice and there’s usually something I like…I mean, definitely like and not just something I will eat.’ Someone felt there were too many non-English dishes on the menu, but knew that alternatives were available. Those who ate in their rooms told us that their meals were sufficiently hot when delivered to them.

People living at the home and visitors felt the home was kept sufficiently clean. They confirmed that staff wore disposable aprons and gloves when helping them with personal care. Information in people’s bedrooms included information on infection control measures.

People were satisfied with the facilities in their bedroom, including lighting for reading in the evenings. Some people particularly appreciated the views from their rooms, as they could see the sea.

Some people discussed that the care home was without an Activities Co-ordinator at present. Staff provided some recreational activities, such as hand massage and manicures, with entertainment by visiting musicians particularly enjoyed.

One person, when asked about the staff, told us ‘You can have a laugh and a joke with them...’ People praised certain staff for their care, approach, and willingness to listen. We asked people if they felt safe with staff and they said they did. One added that they were a nervous person but staff understood them. Two people independently told us that they wouldn’t like it if they had to move to another home.

There was a committed staff team who received training and supervision to provide safe care and treatment, although some staff lacked skills or knowledge to appropriately support people with more diverse needs.

People thought there were enough staff around, and confirmed that if they wished to talk to senior staff this was easily arranged. We asked people if they felt able to make a complaint. One said they did, adding ‘I’m able to say what I like to them.’ Another said they hadn’t needed to complain, because the home ‘dealt with the small things’.

Two people told us they would speak to the director, who ‘was on the end of the phone’.

People were also positive about the home care service. A relative who supported someone receiving a service, when summarising their overall view of this service and the support it had provided to their family, told us the manager was responsive, and the service was ‘FANTASTIC - in capital letters’.

There was evidence in people’s records that they had been consulted when senior staff had carried out assessments of their needs and written their care plan. The views of relatives and others supporting people using the service were also taken into account, particularly when people did not have mental capacity. Care records did not show how decisions about individuals’ lack of mental capacity had been reached, however.

People felt they were given enough choice in their daily lives, and that staff supported them in making decisions for themselves. Care records reflected discussions with individuals to resolve any issues or concerns and agree on the support to be provided. They had an opportunity to share if they had legally appointed someone to represent them, or if they had an advance directive.

People were happy with the support they received, and confirmed that staff were observant of their general health and mood, noticing if they were ‘under the weather’ and so on. Someone required the use of equipment to meet their mobility needs, and they were satisfied with how staff assisted them in this. Those who needed support regarding meals were also satisfied with how this was provided. There was a risk that people who required support for their medication needs might not receive this in a safe way because there was not always sufficient information for staff to ensure they manage people’s medicines appropriately.

When we asked people about measures taken by staff to prevent cross-infection, they told us that each staff member had a holdall in which they carried supplies of disposable gloves and aprons which they used at people’s homes.

Everyone we spoke with felt staff upheld people’s privacy and dignity, with one person saying about the staff member that assisted them, ‘I wasn’t looking forward to anyone helping me with a bath, but her manner is so good…’ People confirmed that staff did not talk about other people that they supported, nor did they talk about their own lives. One person added ‘They seem to like to listen to you talk.’ Read the full inspection report (PDF)

Reports under our old system of regulation (including those from before CQC was created)