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Archived: PineHeath Inadequate

Reports


Inspection carried out on 28 March 2017

During a routine inspection

This inspection took place on 28 March 2017 and was unannounced. Our previous inspection carried out on 10 and 15 November 2016 identified eight breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This inspection found that limited improvements had been made and determined that the provider was still in breach of seven of the same regulations. Three of these regulations were in breach for the third consecutive time as a result of an inspection.

Pineheath is registered to provide accommodation and personal care for up to 44 people. At the time of this March 2017 inspection there were 28 people living at the service, some of whom were living with dementia.

A registered manager was 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.

We found considerable maintenance issues that had not been addressed, including window and drainage problems. Safety concerns relating to unlagged hot pipes and unprotected heated towel rails that had been identified during our November 2016 inspection had not been addressed. We again found cleanliness and infection control issues that could put people at risk.

Plans to identify and mitigate risk to people in relation to their health were not clear. We had concerns about people not receiving prescriptions promptly which meant that they did not receive treatment for health conditions to help reduce their symptoms.

Despite training being received about the Mental Capacity Act 2008 there was minimal understanding and poor adherence to the requirements to ensure that people’s rights were protected. There were substantial gaps in staff training so people could not be sure they were being supported in a safe and appropriate manner.

We again observed considerable poor practice that was not respectful to people and did not uphold their dignity.

People’s care records were not clear, accurate or up to date. They did not provide staff with sufficient guidance about how people’s needs should be met.

The provider remained minimally engaged in the day to day running of the home. Despite the significant improvements required they had failed to improve their oversight of the service or provide enough support in order that improvements could be made.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually

Inspection carried out on 10 November 2016

During a routine inspection

This inspection took place on 10 and 15 November 2016 and was unannounced. Our previous inspection carried out on 15 and 16 January 2015 had found that there were three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to premises maintenance, infection control concerns and care records.

This November 2016 inspection found that these concerns had not been addressed or where they had been addressed the provider was still in breach of the same regulation for other reasons. In addition we identified further serious and multiple concerns. The provider was now in breach of a total of nine regulations. We have also made a recommendation that the provider reviews staffing arrangements.

Pineheath is a residential care home for people who do not require nursing care. It is registered to accommodate 42 people. At the time of this inspection there were 40 people living in the home, three of whom were in hospital at the time. Some of these people were living with dementia.

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.

This inspection was brought forward following concerns received about the home’s heating and hot water supply. When we commenced our inspection on 10 November the home had been reliant upon portable heaters to heat the home as the heating had failed on 30 October. Despite the use of portable heaters one person had been admitted to hospital with a low temperature.

On the first day of our inspection we found that whilst some parts of the home were warm, others were cooler. The provider had failed to obtain sufficient quantities of thermometers to monitor temperatures in the home and the monitoring that had taken place was not robust. The hot water was being supplied by immersion heaters. However, these did not ensure an adequate supply of hot water at suitable temperatures. We found that several windows were in a poor condition and allowed streams of cold air into the building.

By the second day of our inspection an emergency boiler had been installed which supplied heating to the home. The home now was warm. However, the hot water supply issues remained. North Norfolk District Council’s Environmental Health team issued two improvement notices in relation to the water supply.

On the second day of our visit we widened the scope of the inspection. We found considerable concerns in relation to cleanliness and infection control in the home. We referred these matters to Norfolk County Council’s public health team for care homes.

We identified scalding risks in the home and areas of risks specific to individuals. People’s medicines were not being appropriately managed.

Staff training needed improvement and knowledge and application of the Mental Capacity Act 2005 was poor. Many people in the home were living with varying degrees of impaired cognition, but no mental capacity assessments had been undertaken.

Whilst some staff promoted good practice, others did not. We observed that some people’s needs were not adequately identified or responded to during our inspection.

The provider was minimally engaged in the day to day running of the home. They visited fortnightly but did not undertake any documented reviews to determine whether the care and support people received was satisfactory. The provider did not oversee any of the audit arrangements in the home. The manager received little support or guidance from the provider and no supervisions or reviews of their management of the home. Both partners in the business told us they felt that the home provided a good service for people.

The overall rating for this service is ‘Inadequate’ and

Inspection carried out on 15 and 16 January 2015

During a routine inspection

This inspection took place on 15 and 16 January 2015 and was unannounced and carried out by one inspector.

Our previous inspection of 25 April 2014 identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. One of these was with regards to the absence of personalised risk assessments which were required to assess and reduce risks specific to individuals (Regulation 9). During this inspection we found risk assessments in place appropriate to the individual. We were satisfied that this regulation was no longer being breached.

The second breach found during the April 2014 inspection related to the incompletion of body map charts and repositioning records (Regulation 20). This inspection found there were still gaps in the charts of people who required repositioning to prevent or ease pressure areas. We also identified that the recording of the administration of topical creams needed improvement. The provider was still in breach of Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Some of the flooring needed attention as it had deteriorated and become unstable in some communal areas and had been in this condition for some time. One person’s bathroom had cracked floor tiles that had lifted from the floor base. These issues presented safety risks to people living and working in the home and required remedial action. This was a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.  

We identified a strong, unpleasant odour on the ground floor on both days of our inspection. The manager was aware of this, but the situation hadn’t been remedied. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 during this inspection. You can see what action we told the provider to take at the back of the full version of the report.

PineHeath is a residential care home for people who do not require nursing care. It is registered to accommodate 42 people, but at the time of this inspection 37 people were living here.

The acting manager who was present at the April 2014 inspection had subsequently applied for registration as the manager of the home with the Care Quality Commission. This had been approved. 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.

People were happy with the service they received. There was a positive, friendly and open culture within the service. People were treated considerately and respectfully. The manager and staff were approachable and sociable with people living in the home. People were encouraged to share their views and participate in day to day matters in the home. The service sought to include everybody to the extent that they wanted to be included.

The service accessed the support of health professionals when necessary. When people’s needs changed action was taken to ensure their changed needs were met by staff. Staff were confident they had the skills and experience to support people safely. The manager or senior staff members were also available for assistance and guidance when required. People were sure they were safe with the staff and that staff knew how best to assist them and how and when they liked to be supported.

Inspection carried out on 25 April 2014

During Reference: not found

Inspection carried out on 25/04/2014

During a routine inspection

PineHeath is a home providing accommodation for up to 42 older people. There were 34 people living in the home when we visited. The service provides residential and nursing care to older people, some of whom live with dementia. PineHeath does not have a manager who is registered with the commission.  

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS), and to report on what we find. The DoLS are a code of practice to supplement the main Mental Capacity Act 2005 Code of Practice.

We looked at whether the service was applying the DoLS appropriately. These safeguards protect the rights of adults using services by ensuring that if there are restrictions on their freedom and liberty these are assessed by professionals who are trained to assess whether the restriction is needed. The acting manager told us there were some people living in the home who needed to be assessed in relation to their capacity and therefore an authorisation might need to be arranged. We found that PineHeath needed to make improvements to ensure it was meeting the requirements of the DoLS.

People told us they felt safe in the home and we found that there were policies and procedures in place to protect people from harm. People told us they received care which met their needs and promoted their well-being and we saw that staff were trained and understood people’s requirements.

People’s care and support needs were recorded but information about risks to their health and well-being was not available. This meant people’s risks were not managed appropriately and staff could not follow effective risk assessment management policies as they were not in place. You can see what action we told the provider to take at the back of the full version of the report.

We found that people’s repositioning charts and body maps were not updated or fully completed by staff, therefore it was not clear if people had received the care they required. You can see what action we told the provider to take at the back of the full version of the report.

The service followed current and relevant professional guidance about the management of medicines, and staff had sufficient training to enable them to manage people’s medicines safely.

We observed that people were treated with dignity and respect by staff who were caring and considerate.

We viewed records and observed staff’s practice which showed that people’s nutrition and hydration needs were identified and monitored where necessary.

The provider had asked for the views of people about the quality of the service they received via a questionnaire. However they had not yet received people’s responses to help identify areas of the service that needed to be improved. Improvements were needed to assess the service.

People in the home and staff, as well as other health professionals, commented on the significant improvements made by the acting manager in creating a compassionate and cohesive staff team. 

Inspection carried out on 15 October 2013

During an inspection looking at part of the service

At this inspection we found that most of the provider's planned improvement actions had been completed to achieve compliance with essential standards. Where improvements had not been fully completed, there were clear plans to do so.

People we spoke with were positive about their experiences of living at PineHeath. One person said that they were ��all fine here. The staff are good.� Another said �I like it here. People [staff] are good.�

People�s records had been developed to ensure that, as far as possible, they participated in social and leisure activities. Their individual needs were properly recorded and there was a clear record of how they had spent their leisure time. We could see that people were encouraged to socialise and join in with organised activities. The needs of those unable or reluctant to do so were met in other ways.

People were unable to choose to have a bath, due to the lack of suitable facilities. This issue was being addressed but progress had been limited due to problems with the home�s drains and water supply. We asked the manager to provide us with further information about this on an on-going basis.

Most staff had received all the training they required to enable them to undertake their roles. A small number of staff required further training and this was planned at the time of our inspection. Staff were also offered regular supervision and an annual appraisal to support them and enable them to meet people's needs effectively.

Inspection carried out on 11 January 2013

During an inspection looking at part of the service

At the time of this inspection there were 39 people living in the home, including some who were living with dementia. Some improvements had been made since our November 2012 inspection; however there was insufficient improvement to show that they had achieved or could maintain compliance with the four outcomes we inspected at this visit.

Most of the people we spoke with were happy with the care and support they received. However, two people using the service told us that they sometimes had to wait a long time for staff to respond to their calls for assistance. One person told us that they had been visited by other people using the service on more that one occasion. They said �They don�t know what they are doing.�

A survey of staff, visitors and people using the service was carried out in December 2012. We were told that the responses were mainly positive, apart from some adverse comments about staff�s response to call bells. No action had been taken to address this.

Inspection carried out on 8, 22 July 2013

During an inspection looking at part of the service

We undertook this inspection primarily to assess compliance with how people were respected and involved in their care. We also assessed compliance in relation to planned improvements that were in progress at our last inspection in April 2013. Unfortunately we found that the provider had not achieved some of these improvements, or maintained compliance with some outcomes.

People we spoke with told us that they were happy living in the home, and that staff looked after them well. We found that the records made about the care that people received were not always complete or regularly reviewed. People received specialist input from visiting health professionals, particularly in relation to their mobility. Risks to people's safety and welfare were addressed by providing effective foot care, specialist seating, pressure risk assessments and moving assessments.

Risks associated with the premises were not identified and managed appropriately. Planned improvements to facilities had not been completed, which meant that some communal facilities were inadequate to ensure that people's preferences could be met. Some signage within the home was misleading to those with limited understanding, or knowledge of the service.

Staff were receiving support to ensure that they could fulfill their roles. However, some staff had not completed planned training and supervision and this was reflected in the care and support that was being delivered, particularly to people living with dementia.

Inspection carried out on 18 April 2013

During an inspection looking at part of the service

At this inspection we looked at the known areas of non-compliance with essential standards that had been identified during three previous inspections in November 2012, January 2013 and February 2013. These related to record keeping; the care delivered to people; how risks were managed; how staff were supported in their roles; and how the quality and safety of the service was monitored.

We found that significant improvements had been made in all areas previously assessed as non-compliant. However, some improvements had been made very recently and some planned actions were still in progress. This meant that we could not be entirely assured that these improvements would be fully completed or maintained.

During our inspection we spoke with many of the 31 people living in the home and also two relatives. They told us that they were happy with the care and support that they, or their relative, were receiving.

We found staff to be enthusiastic about the improvements that had been made and they demonstrated that they understood people�s needs. However, the needs of people who could not express their wishes may not have been fully met. Peoples preferences for how they lived their lives were not always fully considered.

Not all essential maintenance work had been completed and not all staff had completed appropriate training at the time of our inspection. However, there were plans in place to ensure that this happened.

Inspection carried out on 8 February 2013

During an inspection looking at part of the service

Following our inspection on 2 November 2012 the provider sent us an action plan to show how they intended to make improvements and become compliant with outcomes 14 and 21. They told us that they expected to achieve compliance by 31 January 2013. At this inspection we found that whilst some improvements had been made but the provider had not achieved compliance as planned.

We spoke only briefly to people living in the home during our inspection. Those we spoke with told us that they were happy with the care and support they received.

The provider had introduced new arrangements for record keeping, staff training, staff supervision and appraisal. New care records were being introduced and the records that indicated how individuals wished to be treated in an emergency had been reviewed and were stored accessibly. A staff training programme was planned and staff supervision had commenced. However, we found that not all of the new arrangements were fully implemented or effective.

During our visit we identified some concerns about the knowledge and competence of some staff in relation to their fitness for their roles, which had not been addressed through training or supervision. When we spoke with some staff they demonstrated a lack of understanding of the importance of completing accurate records in relation to people�s needs.

No audit of care records had been completed since our last inspection and no training in records keeping had been delivered to staff.

Inspection carried out on 2 November 2012

During an inspection in response to concerns

We saw that staff protected people�s privacy and offered them choices. People said that there were enough activities going on within the home. However, one person remarked that there were too many people in the lounge to enable them to watch television.

People told us that they were happy with the care and support they received and that that staff responded promptly to their requests for assistance. They described staff as �...very good�; �...kind� and �...willing�. One person said �They will do anything for you.�

People�s care needs were assessed; however there were no clear plans of care and support in place and risk assessments were not always updated appropriately. People�s records were stored securely, but were not always accurate and fit for purpose. Whilst records were well organised, most did not include all the information required to enable staff to support people effectively and safely.

We found that the provider did not effectively monitor the quality of the service and this meant that they did not always ensure that required improvements were made.

Whilst the home was welcoming and clean, we saw that some hazards had not been identified, or managed. However, people told us that they liked their rooms and were happy with the home�s facilities.

We found that most staff members� training, supervision and appraisals were out of date. The manager had begun to address these shortfalls, but new arrangements were not fully implemented when we visited.

During an inspection looking at part of the service

We did not need to visit Pine Heath Care Home during this review. Therefore we did not seek the views of people using the service on this occasion.

Inspection carried out on 22 February 2012

During an inspection looking at part of the service

During our visit we observed people receiving care and spoke briefly to people about living in the home. People were positive about their experience of living at Pine Heath and said that they were happy there. One person told us that they felt able to express their views to staff about the service they received.

Inspection carried out on 26 July 2011

During a routine inspection

During our visit on 26 July 2011 people with whom we spoke were positive about their experience at Pine Heath. They told us that staff were, �Kind and respectful� and that they were happy with their accommodation and had everything they needed. They told us that the hairdresser visited every week and that they enjoyed having their hair done.

People living in the home were complimentary about the care they received and also about the food. People told us that they liked the organised activities and they spoke positively about the recent garden party and the musical entertainer who regularly visits the home.

A family member of one person who was being cared for in bed with changing needs said that they were very happy with the care that their relative was receiving and felt well supported by staff at a difficult time. Another person said, �They look after us well. They know what they are doing.�

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