Archived: The Pines Care Home

Updated 8 June 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place over two days on 5 and 8 January 2016. The first day of the inspection was unannounced. The inspection team consisted of two adult social care inspectors, a specialist advisor who was a registered nurse with experience of nursing care of older people and an expert by experience. The expert by experience had experience of caring for someone who uses this type of service.

Before our inspection, we reviewed the information we held about the service. This included the action plan, which the provider had submitted following inspections in January and September 2015. We reviewed information we had received about the service and notifications that the provider had submitted. We asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. The PIR was returned as requested.

We contacted North Yorkshire local authority and Healthwatch. This organisation represents the views of local people in how their health and social care services are provided. This information was reviewed and used to assist with our inspection.

During the inspection we spoke with 13 people who used the service, four visitors and a visiting GP. We observed the staff handover from the night care staff to day staff.

Throughout the inspection we also spent time with people in the communal areas of the home and in their rooms observing how staff interacted with people and supported them. We observed the mealtime experience and a member of the inspection team shared a meal with people.

We spoke with the operations manager, area manager, deputy manager and all the care staff present. We also spoke with the cook, administrator, maintenance person and the domestic.

We reviewed electronic records for three members of staff and care records for nine people. We checked the records relating to the management of the home such as training records, maintenance records and quality assurance audits and reports.

Updated 8 June 2016

We carried out a comprehensive inspection of this service over two days on 5 and 8 January 2016. The first day of the inspection was unannounced.

At our last inspection on 22 September 2015 we identified continued breaches of legal requirements in relation to the care and welfare of service users, staffing levels and staff training, which impacted on staff ability to provide safe, consistent care. Audit and quality assurance systems had not been effective in identifying and addressing problems.

The Pines Care Home provides personal care and accommodation for up to 30 older people. Accommodation is provided over four floors, which are accessible by passenger lift. There are a range of communal facilities including two lounges, a dining room, conservatory and an enclosed garden area. When we inspected the service was providing care to 13 people who were all accommodated on the lower ground and ground floors.

At this inspection we found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment and the governance and leadership of the service. We also found shortfalls in staffing, person centred care and the environment.

The service did not have an operational registered manager in place. 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.

We found that processes were not robust and safeguarding processes had revealed that people had not always been protected from the risk of harm. The provider had failed to take appropriate action to identify risks to and manage those risks to ensure people’s safety. There was an inexperienced management team and staff were not being deployed effectively to meet people’s care needs safely. Staffing levels were not assessed against the dependency levels of people using the service. We were told staffing had been reduced because the service was running on low occupancy levels. However we observed periods of time when staff were trying to support people with a variety of tasks. This meant staff were rushed and people did not experience good care.

The environment was not safe or suitable for people living with dementia because it had the potential to increase disorientation and there was little in the way of dementia friendly prompts and signage. There were some uneven areas in the corridor floor on both the lower and ground floors which could pose potential difficulties for people with dementia or mobility problems.

Care staff had not received the training and support they needed to be able to deliver effective person centred care for people who used the service. We observed examples of poor care practice, including the way that medicines were being handled, which placed people at further risk of receiving unsafe or inappropriate care.

People were not supported to maintain their nutrition and ongoing healthcare needs in a timely way. We witnessed examples of unacceptable staff practices where we had to intervene to make sure people were supported to eat and drink or take their medicines in a safe way. We also had to prompt staff to seek medical input for some people. Overall we had to refer six people to the Local Authority safeguarding adults teams as a result of our findings and concerns over people’s welfare. We will continue to monitor these and liaise with the local authority as needed.

We received negative feedback and observed that not all staff were caring towards the people they were supporting. We observed curt and uncaring attitudes and verbal responses from care workers who were clearly not trained or supervised in how to provide good customer care. People were not routinely involved in decisions about their care. People felt that concerns were not listened to or acted upon. People’s preferences were not always taken into account when staff were delivering their care.

The provider had failed to put effective systems in place to gather the views of what people felt about the quality of the service. The systems in place designed to identify and bring about improvements in the service were ineffective.

We had to ask the provider to take urgent steps to ensure people’s safety during the inspection which mainly involved improvements to staffing, people’s safety and welfare and management.

As a result of the amount and seriousness of the regulatory breaches we are currently following our enforcement procedures and will report on this once completed.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review.

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 service will continue to be kept under review and, 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. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.