The Pines Residential Care Home

The Pines Residential Care Home is a care home providing accommodation and personal care for up to 28 people, both younger and older adults. At the time of the inspection there were 20 people living at the home.

The Pines accommodates people in a converted and extended building with rooms situated over two floors, with access to the upper floors via a lift and stairlift. Some rooms have access to en-suite facilities. There are a range of communal areas and a large garden at the front and side of the building and a small courtyard area to the rear.

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

Risks related to the delivery of the service were monitored and assessed. Since the previous inspection the provider had fitted new window restrictors at the home and had revised the fire procedures to ensure proper drills were taking place. Risks associated with people’s care and wellbeing were regularly reviewed and advice sought from health professionals.

Staff training records were up-to-date and action had been taking to ensure staff maintained their skills. A new training system was being introduced by the provider to further support staff development. Care plans were regularly updated to reflect the latest professional advice and professional guidance was followed. Care plans contained a range of information appropriate to people's individual needs and reviews were conducted regularly.

Medicines were managed safely. The home was maintained in a clean and tidy manner. Appropriate processes were in place to manage the current COVID 19 pandemic and staff were using appropriate levels of PPE (Personal Protective Equipment.)

New menus had been introduced and people's specialist dietary needs were catered for. People were supported to access a range of health and social care appointments to maintain their well-being. 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.

Some redecoration of the home had taken place and further developments were planned or in progress. Improvements were taking place with the outside space to support garden visits during the pandemic. People told us the staff were supportive and delivered personal and appropriate care.

There was a registered manager who was no longer working at the home but had not cancelled their registration with the CQC. We had previously spoken with the provider about this. The current manager was actively pursuing registration.

Audits and checks on the home had improved and the manager had a good understanding of matters that still required attention. Staff told us management of the home had greatly improved and they felt well supported in their roles. The provider met with the manager on a regular basis and visited the home more frequently. People and staff were actively involved in the running of the home and developing support.

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 (published 17 January 2020) and there were multiple 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.

We carried out an unannounced comprehensive inspection of this service on 25 and 26 November 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: person centred care; safe care and treatment; staffing and leadership (Well-led).

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 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 The Pines Residential Care Home 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.

The Pines Residential Care Home is a residential care home providing personal care for up to 28 people aged 65 and over. At the time of the inspection there were 18 people living at the home.

The Pines accommodates people in a converted and extended building with rooms situated over two floors, with access to the upper floors via a lift and stairlift. Some rooms have access to en-suite facilities. There are a range of communal areas and a large garden at the front of the building and a small courtyard area to the rear.

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

At the time of the inspection the home was under organisational safeguarding. Organisational safeguarding is a process instigated by the local authority where there are a range of concerns about the service. Risks related to the delivery of the service were not always monitored and addressed. Windows on the upper floor did not have appropriate restrictors in place; although the provider subsequently took action to address this. There had been no active fire drill at the home since January 2019 and whilst risks associated with care delivery were monitored, it was not always clear these were incorporated into care records.

Staff training records were not fully up to date and showed significant gaps in training. There was no robust system to monitor training. Care plans were not always updated in a timely manner to reflect the latest professional advice and staff were not always following professional guidance when supporting people.

Care plans contained a range of information appropriate to people’s individual needs, although reviews of care were often limited. Some activities were available at the home, but they did not always address people’s individual needs. Relatives told us they were always welcome at the home and could visit at any time. There had been no recent complaints, but people told us they knew how to raise concerns, if necessary. End of life care needs were included in people’s care plans but often lacked personalised detail.

Staff recruitment was carried out safely and effectively. Medicines were managed safely, and the home was maintained in a clean and tidy manner.

People’s records showed their needs had been assessed prior to them coming to live at the home. People told us they enjoyed the food and people’s dietary needs were catered for. People were supported to access a range of health and social care appointments to maintain their well-being. 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. Some areas of the home were in need of redecoration and refurbishment. The provider told us there were plans in place for 2020.

People and relatives told us the staff were supportive and delivered timely and appropriate care. We observed staff support people with kindness and consideration. Staff had an understanding of issues related to equality and diversity and training was provided around this subject. People were supported to make day to day choices, although alternative methods of presenting information were not always available. People told us staff respected their privacy, maintained their dignity and helped support their independence.

The registered manager was on long term absence from the home and the deputy manager was in charge. Audits and checks on the home were variable and had not identified the concerns found at this inspection. The provider told us they visited the home regularly but there was no evidence of a formal review or oversight. Staff praised the deputy manager highly and said they were trying to address matters and make improvements at the home. There was some involvement of people through meetings, but these were infrequent.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 24 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to personal care, as staff were not always following professional advice. Staff training which was not fully up to date and not robustly monitored. There were issues around safety as risks associated with care and the safety of the environment were not effectively monitored. Leadership and management of the home was not robust, as action had not been taken to address issues and effective quality systems were not in place. Please see the action we have told the provider to take at the end of this report.

We also found that the provider had failed to notify the CQC of a number of events that they are required to do so by law. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We inspected the service on 29 March and 3 April 2017 and found that they had taken appropriate action and were no longer in breach of these regulations. At the last inspection, we had found wardrobes were not secured to the wall so risked toppling onto people, windows were not restricted to prevent falls from height, and fire doors did not have the required seals to work effectively. There was also insufficient storage for medicines. At this inspection we found that wardrobes were secured, windows restricted including the replacement of some older style doors, and new doors had been provided which were compliant with fire safety regulations.

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 checked the management of medicines and found that the treatment room had been refurbished and a new bench, additional cupboards, and a new medicine fridge had been provided. Safe procedures were in place for the ordering, receipt, storage and administration of medicines including controlled drugs.

There were suitable numbers of staff on duty during the inspection. Recruitment procedures were in place which helped to keep people safe from abuse including carrying out checks on the suitability of people to work with vulnerable adults.

Safeguarding policies and procedures were in place. There had been no recent safeguarding concerns, and staff had received appropriate training. They knew how to report any concerns of a safeguarding nature.

Safety checks on the premises and equipment had been carried out, including gas and electrical safety checks, and fire safety equipment. The premises were clean and staff followed the provider's infection control policy to help to prevent the spread of infection. Closed circuit television (CCTV) had been installed in communal areas, to help to keep people safe. Attention had been paid to CQC's policy regarding the use of surveillance in care homes.

Staff received regular training and supervision and felt well supported by the manager and deputy. Annual appraisals were also carried out. Specialist training to support people with specific health or care needs was also provided.

The service was operating within the principles of the Mental Capacity Act 2005 (MCA). Applications had been made to deprive people of their liberty in line with legal requirements and a log was maintained of Deprivation of Liberty Safeguards (DoLS) granted and due for renewal. Decisions made in people's best interests were appropriately recorded.

People were supported with eating and drinking and feedback about the quality of meals was positive. Special diets were catered for, and alternative choices were offered to people if they did not like any of the menu choices. Nutritional assessments were carried out, and action was taken if people were at risk of malnutrition.

The premises were clean and tidy, and people and relatives told us they liked the homely atmosphere. There had been some improvements made to the design and adaptation of the premises to help to support people living with dementia who need additional support with finding their way around the home, and may also experience visual or perceptual problems. Further work needed to be done to improve the environment, and an action plan was in place. We have made a recommendation about this.

We observed numerous examples of kind, caring and courteous care. The privacy and dignity of people was promoted and maintained by staff. Explanations and reassurance was provided to people throughout the day, and staff and people displayed warmth and humour towards each other.

Person centred care plans were in place, and these were up to date and reviewed on a regular basis. Visiting professionals complimented the quality of care records, and told us that staff followed their advice and contacted them in a timely manner for support when necessary. People and relatives were involved in care planning and reviewing care.

A variety of activities were available, including group and individual sessions. An activities coordinator was in post and we received positive feedback about the activities that were available. Relatives and friends were invited to join entertainment or planned events in the home. Trips were arranged to the local community and to places of interest further afield.

A complaints procedure was in place. One complaint had been received although this did not relate to care in the home. This was dealt with appropriately by the registered manager.

People and relatives spoke highly of the registered manager. The registered manager carried out a range of quality and safety audits and the provider visited the service on a regular basis to monitor this. The registered manager advised us that they had resigned from their post and were working their notice period at the time of the inspection. The vacant post had been advertised. A deputy manager was in post.

The home was last inspected on 2 May 2014. We found they were meeting all the regulations we inspected.

The Pines Residential Care Home provides care and accommodation for up to 28 people, some of whom have a dementia related condition.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (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 and associated Regulations about how the service is run.

The local authority had placed the home into ‘organisational safeguarding.’ This meant that the local authority was monitoring the whole home following concerns with certain aspects of medicines management and other practices. A local authority safeguarding officer told us that staff were working with them to address the issues raised.

We found some concerns with the condition of the premises. We noticed that some of the first floor windows had not been fitted with window restrictors. In addition, wardrobes had not been secured to the wall to prevent any accidents or incident. A risk assessment had not been undertaken to assess these risks.

Fire safety checks were carried out. However, we noticed that some of the special strips which were fitted to fire doors or frames to provide a smoke/heat resistant seal were partly missing. We noticed that the lock to the outside kitchen door was not secure. We passed our concerns to the local authority’s fire safety team and contracts and commissioning team.

Infection control procedures were in place. A new sluice facility had been built. We noticed however, this room had not been fitted with racks for the hygienic storage and drying of continence equipment. In addition, this room was unlocked. There was an odour of stale urine in one of the rooms we checked and this smell permeated along the first floor corridor. Following our inspection, the manager told us that this odour had been addressed.

We checked the storage of medicines and found that medicines awaiting disposal were stored on the floor or on top of a filing cabinet because there were not enough cupboards to store medicines safely. We found that other aspects of medicines management such as administration were carried out safely.

Safeguarding policies and procedures were in place. People and relatives told us that people felt safe at the home. Staff told us that they had not witnessed anything which had concerned them and were knowledgeable about what action they would take if abuse were suspected.

Safe recruitment procedures were followed and there were sufficient staff on duty at the time of the inspection. Staff received appropriate training and support to enable them to care for people effectively.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’ it also ensures unlawful restrictions are not placed on people in care homes and hospitals. The registered manager had submitted DoLS applications to the local authority for authorisation in line with legal requirements. Records showed that consent was sought from people and that their capacity to consent is considered and the Mental Capacity Act (2005) (MCA) was applied appropriately.

People were provided with support to meet their nutrition and hydration needs. The cook was knowledgeable about people’s dietary requirements. We saw that assistance was provided on a one to one basis and people

Care was provided with patience and kindness. We observed positive interactions between people and staff. Staff promoted people’s privacy and dignity.

Care plans were in place which documented people’s likes and dislikes and instructed staff about how to meet people’s needs.

A planned activities programme was in place. People were supported to access the local community. A complaints procedure was in place. No one we spoke with raised any concerns about the service. One relative said, “I cannot fault the home.”

There was no deputy manager in place. The manager was carrying out all the audits and checks along with other management duties which meant she had to work extra hours at the service. The home had been through a period of change due to an ongoing safeguarding investigation. The manager said that staff morale was now improving. This was confirmed by staff.

We had concerns with the condition of the premises. We saw that certain issues had not been identified and remedial action had not always been carried out by the provider in a timely manner. We considered that these should have been carried out sooner without our input and prompting.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment and good governance. You can see what action we told the provider to take at the back of this report.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found:

Is the service safe?

We spoke with four relatives and six people to find out their opinions of The Pines. We also spoke with a clinician in challenging behaviour, a local authority reviewing officer, safeguarding officer, contracts and commissioning officer, a representative from a local activities charity and district nurse to find out their views. All spoke positively about the home.

People were treated with respect and dignity by the staff. The local authority's safeguarding adults' officer and contracts and commissioning officer did not raise any concerns about the service.

Systems were in place to make sure that lessons were learnt from events such as accidents and incidents and complaints and concerns. This reduced the risk to people and helped the service continually improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Although no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

Is the service effective?

People were extremely happy with the care that was delivered. They told us that their needs were met. One relative commented, 'The care is second to none.'

It was clear from our observations, and through speaking with staff that they had a good understanding of people's care and support needs.

Is the service caring?

We saw that care workers showed patience and gave encouragement when supporting people. One person informed us, 'The staff are lovely.'

Health and social care professionals informed us that they had no concerns about people's care and welfare. The reviewing officer and member of the district nursing team with whom we spoke informed us that they were happy with the care that was delivered. There was a cheerful atmosphere; many staff had worked there for a considerable period of time. This experience contributed to the efficiency and skill with which staff carried out their duties.

Is the service responsive?

People's needs had been assessed before they visited the service. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives. A holiday had been organised for June 2014, to a local caravan park.

All professionals with whom we spoke were complimentary about the service. They informed us that staff contacted them immediately if there were any concerns. The reviewing officer told us, 'They're really good at listening to any advice and always are willing to take any actions to improve.'

We saw that referrals were made to the GP, district nursing team, challenging behaviour team, podiatrist, dentist and other health and social care workers. We noted that the advice of these health and social care professionals was incorporated into people's care plans which helped ensure staff were aware of this information.

Is the service well-led?

The service had a quality assurance system and records seen by us showed that identified shortfalls were addressed promptly.

The home had a complaints policy and people and relatives told us that they felt able to raise any concerns they had. The manager explained that no formal complaints had been made since 2010.

Staff told us they were clear about their roles and responsibilities. They informed us that regular meetings were held. This was confirmed by minutes of meetings. Staff morale at the home was good and staff spoke positively about working there and the support the manager gave them.

Many of the people who used the service had complex needs, which meant they were not able to tell us their experiences. We spoke with a visiting health professional who told us they had no concerns about the care provided to people at the home. We found that people's care needs were assessed and care was planned and delivered in the interests of people's safety and wellbeing.

We saw there was a choice of nutritious food and people were supported to eat and drink.

We saw there was enough equipment to promote the independence and comfort of people who used the service and the provider took steps to protect people from unsafe or unsuitable equipment.

We found there were effective recruitment and selection processes in place and appropriate checks were undertaken before staff began work. This ensured people were cared for by suitably qualified, skilled and experienced staff.