Pinehurst Residential Home

Pinehurst Residential Home (referred to as Pinehurst hereafter) is a residential care home registered to provide accommodation and personal care for up to 20 people of all ages who may have mental health needs. The home is a large end of terrace property with access to a private park. Accommodation is provided over three floors. Pinehurst is situated within easy reach of the town centre of Dawlish. At the time of the inspection, 17 people were living at the home.

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

People and relatives praised the home, describing the support provided as “perfect” and “excellent”. One relative said people were treated like “royalty” and the staff respected everyone. People felt safe and well cared for. One person said “Yes, a 1000 times yes” and “I wouldn't leave here for a million pounds. This is a wonderful place. I'm very well looked after.”

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.

People’s decisions about their care and preferences were respected. Staff were sensitive and attentive to people’s needs. Staff were seen to be kind, caring and friendly and it was clear staff knew people and their relatives well. People, relatives and staff said the home was well managed. Healthcare professionals said they had a good relationship with the home.

Care plans, risk assessments and information about how to support people at times of anxiety had been reviewed and rewritten. These now provided accurate and clear guidance for staff about how to support people in a way which caused the least amount of distress, and which helped to prevent further decline in people’s mental health.

People continued to be supported to lead full and active lifestyles, follow their interests, and take part in social activities. People were supported to have a presence in the community, and we saw people coming and going freely to the local town.

There were sufficient numbers of staff employed to ensure people’s needs were met. Staff had time to sit and engage people in conversation and to support people’s involvement in social activities. Recruitment practices were safe, and staff were well-trained. Staff were aware of their responsibilities to safeguard people.

People received their medicines safely and as prescribed. Medicine management practices were safe.

Quality assurance processes had been introduced which allowed the assistant manager and registered manager to review the quality and safety of the care provided.

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 (inspected 13 November 2018 with the report published 4 January 2019). There were three breaches of regulation. 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected: This was a planned inspection based on the previous rating.

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.

People told us they liked living at Pinehurst. They said they felt safe and they had a good relationship with staff. The relative we spoke with described the staff as “superb” and “excellent”. Staff knew people well and described to us people’s likes, dislikes and preferences. Our observations showed people were treated with kindness and respect. There was a relaxed atmosphere between people and staff, with friendly conversation.

Staff understood their roles to protect people from harm and to promote their independence. Records showed action was taken to reduce risks to people’s safety and welfare. However, risk assessments and management plans did not include this information for staff about what actions to take to protect people. Care records also required improvements to fully describe people’s abilities and needs. This meant people’s care needs might not be fully known and understood by the staff, particularly those new to the home.

Recruitment practices were not always safe; some staff had not had pre-employment checks carried out or references obtained from previous employers.

Staff had received the training they required to undertake their role. This included training in health and safety topics as well as those relating to people's mental health needs.

Medicines were being managed safely and people were supported to attend healthcare appointments. Specialist support was provided by the community mental health team.

People’s rights, privacy and dignity were protected. Where it was necessary to make decisions on people’s behalf, this was done after appropriate capacity assessments had been undertaken.

At the time of the inspection, the home did not have effective systems in place to assess, monitor and improve the safety and quality of the service. Immediately following the inspection, management processes were reviewed and quality assurance systems developed.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. We made one recommendation for improvement.

More information is in the detailed findings below.

Rating at last inspection: Good (last report published 9 July 2016)

About the service: Pinehurst Residential Home is a residential care home registered to provide accommodation and personal care for up to 20 people of all ages who may have mental health issues. The home is a large end of terrace property with access to a private park. Pinehurst is situated within easy reach of the town centre of Dawlish.

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

Enforcement: We have issued three requirement notices which can be found at the end of this report.

Follow up: We will continue to monitor the intelligence we receive about the home until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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.

People expressed a high level of confidence in home. They told us they felt safe and happy living at Pinehurst. The atmosphere of the home was calm and relaxed throughout our inspection. There was laughter and appropriate banter between staff and people living at the service, as well as opportunities for quiet conversation.

People were supported by staff that knew them well. Staff were kind and caring and people spoke very highly of the care they received. One person said “The atmosphere is lovely, staff are nice, [name of registered manager] is great and you’re treated like you are one of the family”. There were enough staff available to meet people’s care needs safely. Staff worked in a calm, unhurried way and had time for talking and supporting people with activities of their choice. People were encouraged to maintain their independence and to be part of the local community.

Staff ensured people's privacy and dignity was respected at all times. They worked closely with people to ensure they understood their needs and preferences. People were involved in planning and reviewing their care and felt listened to by staff. Staff demonstrated a shared commitment to the wellbeing and care of the people they supported and respected people’s right to individuality and difference.

People were able to follow their interests and hobbies. There was also a range of activities available within the home which people enjoyed. Many people went out every day, either independently or supported by a member of staff. Staff had time to spend individually chatting with people. There were two holidays organised by the registered manager each year, where a group of people went away for a few days, supported by staff. These were greatly enjoyed.

Staff had received training in safeguarding adults and knew how to raise concerns if they were worried about anybody being harmed or neglected. They felt confident that if they had any concerns they could raise them with the registered manager and they would be acted upon quickly and effectively. One person said “If I was feeling nervous or unsafe I could go to anyone here, I feel perfectly safe”.

We observed medicines being administered and this was done safely and unhurriedly. Medicines were stored safely and all stock entering and leaving the home was accounted for. Staff received regular training in medicines management and medicines audits were completed to ensure consistent safe practice.

There were robust recruitment processes in place to ensure that suitable staff were employed. Staff were well supported by the registered manager through supervision and appraisal. High standards of care were encouraged through staff training and development. Staff participated in a wide range of training courses in topics relating to people’s care needs including medicines management, mental health, health and safety and safeguarding.

Staff had received training in, and understood the principles of the Mental Capacity Act 2005 (MCA) and the assumption that wherever possible people should make their own decisions about their care and treatment. We found that the registered manager had not fully understood how the MCA should be applied in a mental health setting. However, immediate actions were taken to remedy this, including seeking assistance from the community mental health team with a capacity assessment for one person and seeking MCA training provided by Devon County Council. We found there had been no detrimental effect on people living at the service.

We have made a recommendation about staff training on the subject of the Mental Capacity Act (2005).

Records showed each person had been assessed before they moved into the home and any potential risks to their health and welfare were identified. Where risks were identified there were measures in place to reduce these. We saw that staff were skilled at managing risks in relation to people’s mental health. We were told by health and social care professionals that the service was very good at recognising signs of people becoming unwell and supporting people safely at times of crisis. A social worker told us staff were “quick to recognise and act if mental state becomes risky”. The service’s ability to respond proactively to signs of people’s changing mental health meant that people achieved levels of mental stability that had not had in the past.

People were supported to eat and drink enough to ensure they maintained good health. We spoke with people about their meals and whether they enjoyed the food that was provided. Most people were positive. They said “Food is very nice and you just ask for an alternative if you don’t like it. They are very flexible”. However, some people said they would like more choice, particularly at teatime. We talked with the registered manager about this and they said that the menu choices were all generated by people themselves and people could always choose an alternative. However, they would encourage further discussion about this at the next house meeting and seek some new ideas.

People were supported to maintain good health from a number of visiting healthcare professionals. People told us they saw their GP or mental health worker when they needed to and we saw from records that there was close communication with health and social care professionals.

The culture of the home was person-centred, open and friendly. There was clear leadership from the registered manager. Quality monitoring systems were in place which were used to review and improve the service. There was ongoing investment in the home to ensure that the environment was well maintained and updated. The environment was safe, clean, homely and welcoming.

Not all notifications had been made to the Care Quality Commission in line with the provider’s legal responsibilities. This had not had any detrimental impact on people. We have made a recommendation about the registered manager keeping in touch with current CQC guidance.

People's needs were met by the adaptation, design and decoration of the service. There was an ongoing programme of maintenance at the home. It was decorated and furnished in a comfortable, homely way. The space was big enough for people to find some personal space when they needed it.

One inspector visited the home and looked to answer the question, is the service safe?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with staff and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Was the service safe?

Systems were in place to make sure that medication was managed effectively.

People who lived at the home told us they were well looked after and were happy. One person said "I like it here, wouldn't improve anything.'

We saw that care workers respected people's wishes and people told us they felt respected. People's privacy was protected by care workers. For example we saw care workers knocked or doors and waited to be invited in before entering people's rooms.

People had not been protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

People were cared for by suitably qualified, skilled and experienced staff. One care worker told us "I love this job, I absolutely love it".

The provider had an effective system to regularly assess and monitor the quality of service that people received.

People who lived at the home were aware of how to make a complaint if they were unhappy.. We asked one person whether they would feel comfortable making a complaint. They told us that they would and added 'Not made one yet, don't think I ever will'.

One person told us "I like it here ' it's a good place ' it's my home".

People expressed their views and were involved in making decisions about their care and treatment. People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. There were enough qualified, skilled and experienced staff to meet people's needs.

People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.