We carried out a review of the data available to us about Pinehurst Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Pinehurst Care Home, you can give feedback on this service.
Pinehurst is a residential care home providing personal care and support to 20 people aged 65 and over at the time of the inspection. The service can support up to 23 people.
Pinehurst is a Victorian detached house which has been adapted to meet the needs of older people. There are bedrooms on four floors with access via stair lifts. A communal lounge, dining room and conservatory are all on the ground floor.
People’s experience of using this service and what we found
People told us they enjoyed living at Pinehurst. Not many people were able to give us their informed view due to their cognitive impairment. We observed people walking around freely and looking relaxed and comfortable in their surrounding and with staff.
We observed staff assisting people in a kind, patient and compassionate way.
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. The service worked closely with the local older people’s mental health team to ensure people’s rights were upheld but also people were kept safe. Where people living with dementia, for example, needed restrictions in place to keep them safe, this was documented and shared with relevant parties. This included having keypad locks on doors to prevent people leaving the building.
Staff provided care and support in a way which showed people person centred was at the heart of their way of working. Staff understood people’s needs and wishes. Staff had training support and supervision to enable them to do their job safely and effectively. Care plans and risk assessments detailed how staff should support people to maintain their independence as far as possible.
Medicines were safely managed, and people were protected from abuse because staff knew who to report any concerns to.
There were enough staff available on each shift to meet people’s needs in a timely way. Recruitment was robust and ensured only staff were who suitable to work with people who may be vulnerable were employed.
People enjoyed a range of home cooked meals and had a variety of activities planned in line with their hobbies and interests.
Quality monitoring processes had improved to ensure care, support and the environment continued to meet peoples needs.
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 (Report published 27 June 2019).
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
We carried out an unannounced comprehensive inspection of this service on 20 March 2019. 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 safe care and treatment, good governance, consent to care and notification of incidents.
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, effective, responsive 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 on our website at www.cqc.org.uk.
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 Care Home is a ‘care home’ without nursing and is registered to provide accommodation and support for 23 people. At the time of our inspection, there were 21 people living at the service. People living at Pinehurst were older people, some of whom were living with dementia.
People’s experience of using this service:
Risk assessments had not been carried in relation to people’s individual needs and the environment in general. Equipment was not always checked and ensured it was working correctly.
The service did not comply with the Mental Capacity Act 2005 and mental capacity assessments had not been undertaken. For those people being restricted in their lives at Pinehurst, Deprivation of Liberty Safeguards had not all been applied for.
There was a lack of oversight of the service. Regular monitoring of the service had not been carried out to identify any improvements that were needed. There was a lack of service user involvement with people’s views of the service not recently requested.
Systems of governance and oversight were not sufficiently robust to have identified the issues we found in relation to practices, systems and record keeping at the service.
The building needed repair, redecoration and refurbishment in some areas to ensure people were able to live in a safe and comfortable home.
Staff were safely recruited and undertook training to do their jobs properly. Staff did not always receive regular supervision.
There were adequate staff to meet people’s needs. People spoke positively about the staff and said they were kind and caring. Positive relationships had been built between staff and people and their families. People were treated in a non-discriminatory way and encouraged to maintain their independence.
The service worked with local healthcare professionals when required and support people to remain at Pinehurst at the end of their lives.
People enjoyed the food they ate at Pinehurst and received their medicines safely. Activities took place, but these were not always related to people’s individual interests and hobbies.
The registered manager was visible at the service and encouraged an open atmosphere. They were respected by staff. They were aware of the service failings from this inspection and were motivated, passionate and keen to improve the service for people to enjoy living in.
More information is in the full report.
We identified three breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to safe care and treatment, the need for consent and good governance; one breach of the Care Quality Commission (Registration) Regulations 2009 relating to failing to provide notifiable incidents, and one recommendation about improving activities for people living with dementia.
Rating at last inspection:
At the last inspection, the service was rated Good in all areas and as an overall rating (23 September 2016).
Why we inspected:
This was a planned comprehensive inspection based on the last report rating.
Follow up:
We have asked the provider to send us an action plan telling us what steps they are to take to make the improvement needed and meet the breaches of regulation. We will continue to monitor the intelligence we receive about the service. We will return to re-inspect in line with our inspection timescales for Requires Improvement services. If any concerning information is received, we may inspect sooner.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Pinehurst is a 23 bed residential care home; when we visited 21 people lived there. It provides accommodation with personal care to older people, but does not provide nursing care.
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 told us about the good care they received and were complimentary about the staff. They were confident in the staff’s ability to meet their needs. Staff practice showed people mattered, staff were patient, and they demonstrated empathy in their conversations with people and in how they spoke about them. Visitors said they were confident their relatives received kind and compassionate care from a staff group who knew people’s needs well.
Staff developed positive caring and compassionate relationships with people. People were treated with dignity and respect and their human rights were upheld. We have recommended the service ensures that mental capacity assessments and best interest decisions are fully documented. We saw this working in every day practice, but care plans did not always fully document this. Following feedback on the first day of the inspection, the registered manager immediately began working on this. She had obtained a decision specific mental capacity assessment and was working through each care file to see where this documentation may be needed.
People experienced effective care and support which promoted their health and wellbeing. Staff that had the knowledge and skills needed to carry out their role. People were supported by enough skilled staff so their care and support could be provided at a time and pace convenient for them. Each person’s needs were assessed and care records had personalised information about how to meet them.
People were supported to express their views and were involved in decision making about their care and were offered day to day choices. Staff sought people’s consent for care and treatment and ensured they were supported to make decisions in their day to day lives. Staff were knowledgeable and had received training and support to do their job competently and effectively.
People said they felt safe living at the home. Staff were aware of signs of abuse and knew how to report concerns. Recruitment processes ensured people were cared for by suitable staff. People knew how to raise concerns and were confident any concerns would be listened and responded to.
People, relatives and staff said the home was organised and well run. The culture was open and transparent. The registered manager had an ‘open door’ policy which staff and people confirmed. Staff worked well as a team and felt supported and valued for their work. The registered manager had worked hard to promote the wellbeing of people living with dementia, both within the home and in the wider community of Ilfracombe. She had been recognised for her work in promoting a dementia friendly town with local awards.
The service had a range of quality monitoring systems, which were well established. Following our feedback, the registered manager said they would update some of the monthly maintenance audits to include checking of window restrictors and hot water temperatures. There was evidence of making continuous improvements in response to people’s feedback and of learning lessons following accidents and incidents. This included changes to menus, more outings and improvements to the fire safety systems within the home following an independent assessment.
The focus of the inspection was to answer five key questions; is the service safe, effective, caring responsive and well-led? Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.
If you want to see the evidence that supports our summary please read the full report.
This is a summary of what we found:
Is the service safe?
People were treated with respect and dignity by the staff. People told us they felt safe. Comments included "always polite and respectful" and "everyone (the staff) is kind and polite".
The registered manager sets the staff rotas. These take into account people's care needs when making decisions about the numbers, qualifications, skills and experience needed. 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. People told us "you just press the buzzer if you need help" and "always enough staff". This helped to ensure that people's needs are always met.
The home had a homely and friendly atmosphere. People told us it was kept clean and tidy. However, we did find that some areas of the home which were unsafe and unsuitable. This was putting people at risk of unnecessary harm. A compliance action has been set for this. We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to ensuring the home is safe for people to live there.
Some systems were in place to make sure that learning from events such as accidents, incidents, complaints and investigations took place. This reduces the risks to people and helps the service to continually improve.
People's care records and risk assessments did not always contain all the information required. This puts people at unnecessary risk of harm. A compliance action has been set for this. We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to keeping accurate care records and individual risk assessments.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. During our visit it was unclear whether some people required a DoLS referral due to their freedom and choice being restricted. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to this matter.
Is the service effective?
People told us they were happy with the care and support they received and felt their needs had been met. They told us "it's lovely - wonderful", "everything is lovely" and "you could not get a better place". Their health and care needs were assessed and, for those people that were able, they were involved in the reviewing their care or support plans.
Relatives we spoke with told us they were able to see people in private and always felt welcome by staff. This showed privacy was respected
Is the service caring?
People were supported by kind and attentive staff. We observed how relaxed and comfortable people were with the staff group. Comments included "good care X receives from fantastic staff", "cannot fault the carers at all" and "staff are very good - we all like living here".
People benefitted from a static staff group that were enthusiastic, motivated and enjoyed their work. Staff comments included "we all help each other out" and "we are like a family, it's like home and we love coming to work".
"Is the service responsive?
People's needs had been assessed before they moved into the home. Records showed that some people's preferences, choices and needs had been recorded and care/support plans had been provided which detailed their needs.
The service involved specialist professionals when necessary to make sure people received the appropriate care. One health professional commented "the standard of care good".
People knew how to make a complaint if they were unhappy. People, staff and relatives felt they could voice concerns and they would be listened to.
Is the service well-led?
The service had a quality assurance system in place. The management of the home was open and inclusive. People were regularly asked for their feedback on the service or treatment they received - this ensured that improvement was continually sought.
We spoke with ten people who lived at the home and with three visiting relatives. Most comments were very complimentary about the care and support received from staff. One person told us ''The staff are all very good. I am quite satisfied. The food is good, staff check we are okay, even at night they do their rounds.'' Another person told us ''I have been here a long time, I can't find fault. It is a very good home. The girls make sure we are all well looked after.'' One person was less satisfied, but when we checked with staff and their records we found they had received the care and support they said was not given.
We saw care and support was well planned and took into account risks. Staff had good training and support to do their job. We spoke with six staff members and they all confirmed they felt supported to do their job and could have their say about how the home was being run.
The home had systems in place to ensure their quality of care was reviewed and took into account the views of people living at the home. The environment was well maintained with health and safety checks, risk assessments and audits being completed to help demonstrate a clean and safe environment for people to live in.
Prior to the inspection visit, we spoke with the local community nurse team who visit people at this home on a regular basis. We also spoke with the commissioning team, who fund placements for people at this home. Health and social care professionals were very complimentary about the care and support people received at this home. We heard that staff ''know their residents well, always call for advice and people always look well cared for, clean and happy.'' During this inspection, most people were out having a Christmas lunch at the local golf club. We were able to speak to two people, who were satisfied with their care and to two staff members. We also check the hot water in most of the bedrooms. We found there to be an issue in two bedrooms, which the provider was already addressing.
We found that people's needs were being met in a timely fashion. We saw that there was written information about their continence needs and support. Regular checks were made to ensure people were kept clean comfortable and their dignity upheld.
We spent time at the home talking to seven people who lived there as well as four members of staff. At the time of this inspection there were 18 people living at the home with three care staff per shift.
We observed how care and support was delivered through different times of the day. Most people that lived at this service have dementia and therefore not everyone was able to tell us about their experiences. To help us understand the experiences of people we used our SOFI (Short Observational Framework for Inspection) This tool allows us to spent time watching what is going on in a service and helps us record how people spend their time, the type of support they get and whether they have positive experiences. Some people using the service were able to tell us their views. We also spoke with two visiting relatives and two health care professionals.
We looked at some of the key records kept by the home. These included care plans, risk assessments and staff training records. This helps us to better understand how well the home is run.
People we spoke with who were able to share their experiences of living at the service were very positive. Comments included 'I have been here about 12 months now and have settled in very well, the staff are all lovely and I feel very well cared for.' One visiting relative told us they visited at different times and different days of the week and were always made welcome. They said 'it's a very happy atmosphere here, the girls work very hard, but are always welcoming.'
We spoke with one visiting health care professional during the inspection and spoke to another following the visit. Both felt that the service met people's needs in a timely way and referred onto health care teams for advice and support as needed. One professional commented 'People are always clean and tidy, we are very happy with the care and support here.'
We looked at how well care and support was planned and reviewed. The plans contained good basic information about what personal, health and emotional care needs people had and how staff should meet these needs. Risk assessments were in place to show how the home identify, manage and minimised any risks for people.
We observed staff providing care and support in a kind and sensitive manner and we were told by staff that they felt well trained and supported to do their job, but that some staff were unhappy with changes to the staff rota and did not feel confident that their views had been listened to.
We observed people experiencing positive interactions with staff trying hard to engage people. There are good systems in place that ensured people's views were listened to and acted upon. The quality assurance system could be enhanced by including a formal process of gaining staff views about the running of the home.
' 'I like it very much here, staff are very kind. I ask for various things and they supply it.'
' 'Very nice here, we have nothing to grumble about.'
' 'The girls are lovely, I am spoilt'
We also spoke to one visiting relative and was told that they were always made welcome and that they could discuss their relatives care and health needs with staff as they wished.
We observed care and support being given in a caring and respectful way. There were several people who were confused and needed guidance and support throughout the day. We observed staff ensuring they were comfortable and guided to communal areas, for meals and assisted to the bathrooms.
We saw that staff brought hot and cold drinks for people. One person told us they had not had a drink since 6.30am that morning, but we checked with staff and were told that they had been served with at least two drinks throughout the morning and after 6.30am.
People we spoke to said that overall they were happy with the meals provided, and that they could ask for something different to the menu if they so wished. One person told us that the week end meals were not as well cooked as the week day, but that overall they were of a good standard. We saw that the meal offered during our visit was well presented. We saw that people who needed assistance to eat were given this support at a pace that suited them.
Staff that we spoke to said that they were well supported and had good opportunities for training. They were able to tell us about the needs of the people living at the home and how they met those needs.
We saw that some of the records relating to peoples needs were not as well maintained as they should be. This could lead to inconsistent care being delivered.
We saw that medications were not always as secure as they should be. This was in relation to controlled drugs, however when we returned two days later to give feedback to the registered manager about the compliance visit, this issue had been rectified.