Archived: Pinehurst Rest Home

Pinehurst Rest Home is registered to provide accommodation, care and support for up to 12 people. At the time of the inspection there were ten people living at the home. There was a registered manager employed at the service. 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.’

Our previous inspection of the home, completed in November 2015 found the provider had breached two regulations. Shortfalls were identified in the management and storage of medicines and maintenance of the premises. Immediately following that inspection the provider wrote to us informing us they had taken corrective action to ensure compliance with the regulations. At this inspection we found the provider was compliant with the regulations.

People were being well cared for and told us they felt safe living at the home. Staff were aware of what constituted abuse and the actions they should take if they suspected abuse. Relevant checks were undertaken before new staff started working at the service which ensured they were safe to work with vulnerable adults.

Staff had the right skills and training to support people appropriately. People told us they felt there were enough staff available on each shift to care for them well. Staff felt well supported by the management team and received regular supervision sessions and appraisals.

Pre-admission assessments were completed prior to people moving into the home. People’s risks were assessed and plans developed to ensure care was provided safely. Accidents and incidents were monitored to ensure any trends were identified to enable action to be taken to safeguard people.

Medicines were handled appropriately and stored securely. Medicine Administration Records (MAR) were signed to indicate people’s prescribed medicine had been given.

People were referred to health care professionals as required. If people needed additional equipment to help them mobilise and keep them safe and comfortable this was readily available.

The manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS). These safeguards aim to protect people living in care homes and hospitals from being inappropriately deprived of their liberty. These safeguards can only be used when there is no other way of supporting a person safely. Staff had an understanding of the Mental Capacity Act 2005 (2005) and how it applied to their work. Records showed appropriate mental capacity assessments had been carried out.

Staff ensured people’s privacy and dignity was protected. People received personalised care from staff who were responsive to their needs and knew them well. Staff created a relaxed atmosphere which resulted in a calm and friendly culture in the home.

People knew how to make a complaint and felt confident they would be listened to if they needed to raise concerns or queries. The provider sought feedback from people and changes were made if required.

People told us they felt the service was well led, with a clear management structure in place. Relatives told us they were always made to feel welcome at any time.

There were systems in place to drive the improvement of the safety and quality of the service.

Below is a summary of what we found. The summary describes 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.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found:

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Risk assessments had been carried out both with regards to people's care needs and to other aspects of the management of the home, for example, the use of moving and handling equipment and emergency events such as a loss of power. Those staff whom we spoke with were aware of people's needs and how to meet them.

Staffing levels were satisfactory for the number of people living in the home. The hours allocated to the acting manager for the management of the home had increased.

CQC monitors the Deprivation of Liberty Safeguards which apply to care homes and nursing homes. The acting manager confirmed that they were aware of recent changes to the use of this legislation and had taken steps to ensure that referrals were made to the local authority.

Is the service effective?

Care records contained evidence that people had been involved in decisions about their care and consented to this. People also told us that staff always checked that they were happy to receive personal care or any other assistance before providing help. The acting manager had undertaken training in the Mental Capacity Act 2005 and had taken steps to ensure that best interest decisions were discussed and recorded for those people who were no longer able to make decisions for themselves.

Is the service caring?

Throughout the inspection we observed that staff were kind and caring and, in some instances, were able to anticipate people's needs. People's privacy, dignity and preferences were respected. People living in the home told us staff were always kind and polite.

Is the service responsive?

We found that people's needs were regularly reviewed and any changes were responded to as necessary either by consultations with health professionals such as GP's or Community Nurses or changes to the way their care was provided.

Is the service well led?

There were systems in place to monitor the quality of the service provided and to identify and manager any risks. Where issues had been identified, such as with the maintenance of the property, an action plan had been put in place. We also found evidence that learning took place from any incidents or accidents to try to prevent future reoccurrence.

The name of a registered manager who no longer works at the home appears on this report. At the time of our inspection they had resigned but had not applied to cancel their registration. The home was supported by an acting manager.

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.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service caring?

' Is the service responsive?

' Is the service effective?

' Is the service well led?

This is a summary of what we found:

Is the service safe?

Care and treatment was not planned and delivered in a way that was intended to ensure people's safety and welfare. People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not always maintained. Care plans were not up to date and did not reflect the care and treatment provided to people.

Risk assessments had not been carried out both with regard to people's care needs, use of special equipment, such as hoists, and to any environmental.

People using the service were not protected from the risk of abuse, because the provider had not taken reasonable steps to identify the possibility of abuse and prevent it from happening. All of the people that we spoke with told us that they felt safe with staff and the care provided. We spoke with staff who told us they understood their responsibility to safeguard vulnerable adults. However, we found that the service had been made aware of incidents that should have been reported and investigated under safeguarding procedures and had failed to do so.

People who use the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises. The property did not have a current electrical safety certificate and repair works to the emergency lighting system had not been completed. Whilst most areas of the home were visibly clean, some areas were in need of repair or refurbishment. We found worn carpet repaired with tape on the stairs, areas of paintwork which were scuffed and damaged and a large crack in a wall in one bedroom.

There were not enough qualified, skilled and experienced staff to meet people's needs. We found that there were only ever two people on duty to care for 10 people and undertake all cooking, cleaning and laundry tasks as well. The acting manager was also a care worker and had no protected time to undertake management tasks. Analysis of the staff training matrix showed that not everyone had received training in areas relating to the needs of the people living in the home. For example, only a few of the current staff group had received training in pressure area care or understanding dementia.

CQC monitors the Deprivation of Liberty Safeguards which applies to care homes and nursing homes. The acting manager confirmed that they were aware of recent changes to the use of this legislation but did not have appropriate policies and procedures in place. Care workers had not been trained in the Mental Capacity Act 2008 or the Deprivation of Liberty Safeguards. It was clear from the use of a lock on the main gate and the removal of the key from the front door that the management and care workers did not understand the legislation and it's application. We found that there were a number of people in the home for whom applications should be made.

Is the service effective?

Where people did not have the capacity to consent, the provider did not act in accordance with legal requirements. People were not asked for their consent to the use of bed rails and there were no records of decisions made in line with the requirements of the Mental Capacity Act 2005 that this would be in their best interest. Care records did not contain evidence of people's consent to their care, or records of mental capacity assessments and best interest decisions in line with the requirements of the Mental Capacity Act 2005.

All the people we met looked clean, well kempt and comfortable. The people we spoke with told us they were happy in the home and received help when they needed it.

Is the service caring?

People's privacy, dignity and preferences were respected. We spoke with two people who told us that staff were kind and polite. Two care workers were able to tell us in detail about people's preferences and the support they needed. We saw that staff assisted people in a kind and respectful manner.

Is the service responsive?

We found a number of issues such as out of date electrical safety certificates and outstanding repair works which had not been attended to.

We also found that people living in the home had various health needs but these had not always been recognised and help from professionals had not always been sought. For example, people were suffering from decreased mobility but occupational therapists had not been requested to review the people concerned.

Is the service well-led?

The previous registered manager had left their employment at Pinehurst in August 2013. The provider had appointed an acting manager and was aware of the legal requirement that they must have a registered manager. At the time of this inspection, the acting manager had not applied for registration with the Care Quality Commission.

There were no systems in place to monitor the quality of the service or identify and manage any risks. This meant that the provider had no means of identifying possible hazards, risks or shortfalls and taking action to put things right.

During our inspection in June 2013 we found shortfalls in the way that care needs were assessed and planned for and that some parts of the home were in need of repair or maintenance. The home's quality assurance systems were also not being used

effectively.

This inspection was carried out to ensure that the service had made the necessary improvements to achieve compliance with the regulations. On the day of our inspection there were nine people living in the home.

We found that people's weights were now being monitored and recorded and that risk assessments were being carried out if an assessment of need identified any risks. This meant that people's needs were assessed and planned for and that care was delivered as required.

An assessment of the building had been carried out and a repair and maintenance programme was underway. We also found that the information gathered by the home to review the quality of its service had been used more effectively.

We found that care plans accurately reflected people's needs and had been drawn up with their involvement.

We found that risks to people's safety had not been assessed and appropriate controls to manage the risk put in place.

We found that the home did not keep accurate records of people's weights.

Activities were available for people who wished to participate in them.

People told us they had enough to eat and drink and were able to choose what they ate and where.

People were cared for by staff who were appropriately trained and developed.

People who use the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises.

We found the home did not have a robust quality assurance system in place to ensure standards in the home were maintained.

You can see our judgements on the front page of this report.

There were nine people living at the home when we visited. We spoke with five people and two visiting healthcare professionals during our visits.

We did not speak with people about the specific reason for our inspection however they told us they were content and comfortable. People also said they were frequently asked by the provider and manager if they were happy with the service.

The health care professionals we spoke with told us they had no concerns about the home. One said, 'It has a nice homely atmosphere. There are no issues with pressure ulcers and people's personal hygiene is good. They call us if they have any concern about a person's skin condition'.

The other professional said, 'As a smaller home it is more personal'.

We found that record keeping had improved since our previous inspection. We saw that records were accurate and important information used to check people's health and wellbeing was recorded regularly.

We saw there were systems in place to monitor the quality of the service provided.