Archived: Pinewood Manor

Pinewood Manor is registered to provide accommodation, nursing and personal care for 31 older people, people who live with dementia and people who have sensory adaptive needs. There were 29 people living in the service at the time of our inspection visit.

The service was run by a company who was the registered provider. There was 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. In this report when we speak about both the company and the registered manager we refer to them as being, ‘the registered persons’.

At the last inspection on 9 September 2016 the service was rated, ‘Requires Improvement’. We found that there was one breach of the regulations. This was because the registered persons had not deployed enough care staff to ensure that people promptly received all of the care they needed. We asked the registered persons to take action to make improvements to staffing levels and at the present inspection we found that this action had been completed.

Also, at the last inspection we identified that another improvement was needed to ensure that people reliably benefited from receiving safe care. This was because there was a shortfall in the level of fire safety protection provided in the service. Furthermore, we noted that the way in which people’s consent to receive care needed to be strengthened in order to ensure that it was effective in meeting their expectations. We also found that there were shortfalls in the arrangements that had been made to ensure that the service was well led. In particular, quality checks had not always been completed in the right way and this had resulted in the persistence of the concerns we had noted.

At the present inspection the service was, ‘Good’. We found that most of the individual concerns we had previously raised had been addressed. We noted that enhanced provision had been made to protect people from the risk of fire and quality checks were being completed. Although further improvements were needed to the way in which the obtaining of consent was recorded, in practice suitable provision had been made to ensure that decisions were taken in people’s best interests.

Our other findings were as follows. There were systems, processes and practices to safeguard people from situations in which they may experience abuse including financial mistreatment. Risks to people’s safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. This included occasions when people became distressed and needed support in order to keep themselves and others around them safe. Also, medicines were managed safely. Background checks had been completed before new nurses and care staff had been appointed. The accommodation was clean and there were robust arrangements to prevent and control infection. In addition, lessons had been learnt when things had gone wrong.

Nurses and care staff had been supported to deliver care in line with current best practice guidance. As part of this, people had been helped to eat and drink enough to maintain a balanced diet. Also, suitable steps had been taken to ensure that people received coordinated and person-centred care when they used or moved between different services. People had been supported to live healthier lives by having suitable access to healthcare services so that they received on-going healthcare support. Although some parts of the accommodation were not well decorated, in general it was adapted and designed in a way that met people’s needs and expectations.

People were treated with kindness, respect and compassion and they were given emotional support when needed. They had also been supported to express their views and be actively involved in making decisions about their care as far as possible. This included them having access to lay advocates if necessary. Furthermore, confidential information was kept private.

Although people received personalised care that was responsive to their needs information was not always presented to them in an accessible manner. However, people had been offered opportunities to pursue their hobbies and interests. Also, the registered manager recognised the importance of promoting equality and diversity. This included but was not limited to supporting people if they chose gay, lesbian, bisexual and transgender lifestyles. People’s concerns and complaints were listened and responded to in order to improve the quality of care. Suitable provision had been made to support people at the end of their life to have a comfortable, dignified and pain-free death.

There was a registered manager who promoted a positive culture in the service that was focused upon achieving good outcomes for people. They had also taken steps to enable the service to meet regulatory requirements. Nurses and care staff had been helped to understand their responsibilities to develop good team work and to speak out if they had any concerns. Furthermore, people, their relatives and members of staff had been consulted about making improvements to the service and their suggestions had been put into action. The registered persons had made a number of arrangements that were designed to enable the service to learn, innovate and ensure its sustainability. In addition, the registered persons were actively working in partnership with other agencies to support the development of joined-up care.

There was a registered manager in post who was registered with the CQC. 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.

At our last inspection on 2 and 3 December 2014, we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to meeting nutritional needs, record keeping, good governance, and consent. The provider sent us an action plan stating that they would address all of these concerns by June 2015.

At this inspection, we found that the provider had taken action on all these areas and was fully meeting the regulations in two areas where breaches were found. We found that the registered manager has put systems in place to monitor the quality of the service. The provider had updated a policies and procedures to reflect good guidance, practice and legislation.

At our last inspection on 2 and 3 December 2014, we asked the provider to take action and make improvements on the way people were being supported during meal times. The registered had employed a new member of staff to assist with meal times. At this inspection, improvements had been made, but there was evidence of poor practice taking place, that included one carer supporting two people to eat at one time. People had to wait up to 30 minutes to receive their meal, as there were not enough staff to support people with eating and drinking in a timely manner. The registered manager did not use dependency tools to identify the level of support people required throughout the day.

At our last inspection on 2 and 3 December 2014, we asked the provider to take action and make improvements regarding staff understanding of the Mental Capacity Act 2005 (MCA). At this inspection, improvements had been made. Staff demonstrated a good understanding of MCA and appropriate referrals were being made to the local authority regarding Deprivation of Liberty Safeguards. The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people's freedom had been submitted and the least restrictive options were considered as per the Mental Capacity Act 2005. However, the registered manager was not effectively recording how decisions were made for less complex decisions. We have made a recommendation about this in our report.

The provider had ensured that medicines were stored safely at all times. Medicine administration records were kept up to date by staff. Only staff that were trained to administer medicines did so.

People were protected against abuse and harm. The provider had effective policies and procedures that gave staff guidance on how to report abuse. The registered manager had robust systems in place to record and investigate any concerns. Staff were trained to identify the different types of abuse and knew who to report to if they had any concerns.

The service appeared clean and tidy and there were cleaning rotas in place to ensure that all areas were cleaned. The provider had ensured that the premises was safe for use and had up to date certificates of safety.

People’s needs had been assessed and detailed care plans had been developed. Care plans had appropriate risk assessments that were specific to people’s needs.

People were supported to have a healthy and nutritious diet. Staff could identify when people required further support with eating and appropriate referrals were made to health professionals and staff were seen to be following guidance provided.

People and their relatives told us they were involved in the planning of their care. Care plans and risk assessments were being reviewed on a monthly basis by staff and at any time when it was required.

People spoke positively about the care staff and the support they provided. Relatives told us they were happy with the support their loved ones received. Staff communicated in ways they were able to understand when giving support.

Staff respected people’s dignity at all times. The provider had ensured that people’s personal information was stored securely and access only given to those that need it.

People were free to choose how they wanted to live at Pinewood Manor. People could decorate their rooms to their own tastes and choose if they wanted to participate in activities. Staff respected people’s decisions.

The provider had ensured that there were effective processes in place to fully investigate complaints. The registered manager kept records of all complaints that included investigations and all communications with interested parties.

The registered manager had put processes in place to improve the quality monitoring systems. However, these were not fully identifying shortfalls within the service. We have made a recommendation about this in our report.

On inspection, we found a breach in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

During this inspection we looked at the records where concerns were noted at our inspection on the 28 June 2013, these related to personal risk assessment, food and fluid intake, monitoring of pressure mattresses and the induction records of new staff. We found that these records were now all accessible for inspection and recorded the necessary information to evidence that people were not being placed at risk of inappropriate care and treatment.

People who lived at the service had a range of assessed needs including some people who had complex dementia and people who had some sensory loss. We received consistent feedback from people, relatives and staff about the relaxed family atmosphere of the service. People described their experiences as: 'I can't emphasise how good it is here, it's like living at home' and 'I am very happy here, I only have to ask and I get help'. Relatives told us 'It is not the prettiest of places but you could not get better care' and 'I have only ever seen people treated with respect'.

People consistently told us that they felt safe living at the service. Our observations showed that people were treated in a kind and respectful way by staff. They were given choices about their meals and about their daily routines. We saw many positive interactions between staff and people who lived at the service which people benefitted from. Staff responded to people's needs promptly and were knowledgeable about their individual needs.

The meal time was relaxed and we observed people being supported to eat their meals in a dignified and timely manner. People described their meal as 'Exceptionally good' 'Good' 'Very nice' and 'Great'.

People consistently told us that they felt safe living at the service, with a person telling us 'Yes I feel extremely safe here'. People and their relatives told us that they felt confident to raise any concerns they had with staff and felt that this would be dealt with promptly.

Not all records needed to be maintained for the safety of people who lived at the service were up to date, this place people at potential risk of inappropriate care.

We found that the home employed a dedicated activities co-ordinator who worked in the home each weekday. We saw that people had access to a range of different activities and people said that they enjoyed the different things available for them to do. We saw evidence that people had choice over their meals and were supported to eat suitable and nutritious meals.

We found that the home had systems in place to manage medication safely. Staff reported that they liked working at the home and were supported by the management team.

We looked at a range of care records for people who used the service and have raised concerns about the lack of documentation about specialist healthcare needs and the potential risks that people may be exposed to. The current system was not found to be sufficiently proactive in recording and monitoring the steps taken to protect people from harm. In particular, we had concerns about the way people who spent most of their time in bed were safeguarded against the risk of pressure damage.