Archived: The Pines Care Home

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.

An inspection was carried out therefore to make sure the remaining people living at The Pines Care Home were receiving appropriate care and support. The service can accommodate up to a maximum of 30 older people who required personal care and support. When we visited there were 20 people living at The Pines Care Home.

We considered our inspection findings to answer 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?

The manager was actively involved in the daily operation of the home and participated in routine tasks. There were enough care staff on duty to meet people's care and support needs. Care staff had received training in moving and handling; falls management, Mental Capacity Act and Deprivation of Liberty Safeguards, and dementia awareness. This focus on training was important as staff developed their skills and prepared them to meet their additional responsibilities.

People were cared for in an environment that was safe, clean and hygienic. Overall, we found the service was comfortable and warm, and it was appropriately furnished.

The Pines Care Home supported some people living with dementia. We found people were able to move freely around the service and had access to an enclosed courtyard garden. However, in the main people needed staff assistance and direction to find their way round. Greater emphasis could be given to environmental considerations including the use of colour and signage to promote and maximise people's independence.

People were afforded a choice of dining areas where they could take their meals. We have asked the manager to consider repositioning the dining table in the conservatory to avoid direct sunlight. Additionally, the manager has agreed to replace bolt locks on the inside of toilet and bathroom doors with suitable locks that could be easily operable from the outside in the event of emergency.

Suitable arrangements were in place to make sure that maintenance checks were routinely carried out. We noted that the annual check for electronic items was last carried out in February 2013 and was therefore due. We have written to the provider and asked them to let us know when this has been completed.

CQC monitors the operation of the deprivation of Liberty Safeguards which applies to care homes. We found that staff had been trained to understand when an application needed to be made, and how to submit one.

Is the service effective?

Records contained good detail about people's life history and preferences. From our observations people were offered choices and they were involved in decisions made about their care and support. Relatives told us they were kept informed of any changes.

People using the service and visitors spoke positively about the care they received. Comments included 'Always helpful and pleasant,' and 'We are like one big family,' and 'We have our ups and downs but on the whole it's really good here.'

Is the service caring?

From our observations people were clean, well dressed and they appeared comfortable in their surroundings. There was a relaxed atmosphere throughout our visit and we observed staff engaged with people in a respectful way.

Is the service responsive?

Care plans were detailed and held information about people's previous interests. We saw some activities took place including 'chair dancing, trips out and sing-a-longs. However this aspect could be developed further to ensure appropriate and personally meaningful activities are organised.

Is the service well-led?

Staff were knowledgeable about the range of community services that were available to assist people with their personal and health care needs. Effective management systems were in place to promote information sharing and partnership working with other health and social care professionals.

At this visit we found that the improvements made in the safe administration of medication since our previous visits had been maintained. We looked at the medicines records and stock for seven people and found the majority of stock levels corresponded with the medication administration records (MARs) and medication was given to people at the appropriate times.

People were protected from unsafe or unsuitable equipment because the provider had appropriate arrangements in place to ensure that equipment was properly maintained and suitable for its purpose. We saw evidence of recent certified LOLER (Lifting Operations and Lifting Equipment Regulations 1998) checks carried out.

Our observations on the day of our inspection showed that there was a sufficient number of staff on duty for the majority of time to meet people's needs.

Records showed a range of systems were in place to monitor how the service was being run. This included audits by staff at The Pines and by the operational management team for the organisation, the majority of which were relatively new arrangements.

Overall we found improvements had been made and people were usually given their medicines safely.

During our October 2012 inspection we identified concerns with the way in which people's medication was being managed. During our inspection in February 2013 we found that no improvements had been made. We found that a number of people living at the home were either not given or offered their medication as prescribed. The medication administration records (MARs) and controlled drug register we looked at showed recording to be poor and inconsistent. Gaps were identified on MARs which made it difficult to determine if medication had been administered or offered as prescribed. We saw evidence on MARs and the controlled drug register that stock levels of certain controlled drugs were not appropriately maintained. This meant that some people were not receiving the correct medication to manage their pain relief and help keep them well. We found that the provider had not ensured that all staff had been assessed as being competent to give medicines and did not have robust quality assurance processes in place to ensure the safe management of medicines. We have asked the provider to address these issues.

We saw that the relevant health care professionals were contacted as people's needs changed. This helped to ensure that the manager had access to expert help and advice to maintain people's health and wellbeing.

Concerns identified during our inspection meant that we looked at the food people had access to. We found that people were not offered a choice of meals and that the home did not have a menu system in place. We have asked the provider to address this.

People were not protected against the risks associated with medication because the provider had not made arrangements to manage medicines appropriately. We have asked the provider to address this.

Most of the people that we spoke with said staff were "kind" and "absolutely fantastic". We reviewed two staff files. All the files contained the relevant pre-employment checks. This meant that the provider was assured that staff were not barred from working with adults or children.

People we spoke with told us that they would tell the manager if they wanted to make a complaint. People said the manager was "very approachable". People were made aware of the complaints system. This was on display in the entrance hallway and provided to people when they arrived at the home.