The Pines Nursing Home

The Pines Nursing Home is a care home with nursing, providing support for up to 50 people. It is located in Putney, in the London Borough of Wandsworth. At the time of our inspection there were 36 people using the service.

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

People told us they felt safe living at The Pines and staff were available to support them if needed. The provider used a dependency tool to work out safe staffing levels which was reviewed regularly. Risks to people were assessed which helped to keep people safe and they were supported to take their medicines on time. Incidents and accidents were recorded and analysed for trends to try and understand why they were occurring so they could be prevented.

Staff received appropriate training that included a thorough induction and ongoing refresher training. We found that staff supervision was not being carried out regularly, but the provider had an action plan to rectify this. People’s dietary and healthcare needs were met by the provider who worked closely with external healthcare professionals such as dietitians and community nurses to support people.

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.

People and their relatives told us that staff were friendly and caring towards them. Staff cared for people in a way that was respectful and dignified.

People had care plans which included their ongoing support needs, these were reviewed every month and there was system in place to alert staff when any records needed updating. End of life care plans were in place and the provider worked with a local hospice to support people. People had access to wide range of individual and group activities which they said they enjoyed. Complaints were recorded and responded to in a timely manner and the provider carried out investigations when any complaints were received.

There was a system of quality assurance checks in place which helped to ensure the service continued to provide a good level of care. There was an open culture within the service. Staff told us they felt comfortable approaching the managers to raise any issues. The provider engaged with people, staff and worked with external healthcare professionals, taking their feedback on board.

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 good (published 20 September 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Pines Nursing Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The first day of the inspection was unannounced, the provider knew we would be returning for a second day.

The Pines Nursing Home is a care home with nursing, providing support for up to 50 people. It is located in Putney, in the London Borough of Wandsworth. There were 34 people living in the home at the time of our inspection.

A comprehensive inspection was carried out on 17 and 23 December 2015 during which breaches of regulation were found in relation to safe care and treatment, consent and person centred care. We then carried out a focussed inspection on 15 November 2016 at which time the provider had met their action plan in response to the breaches found, however we did not improve the overall rating at this inspection as improvements needed to be sustained over a period of time.

There was a registered manager at the service. 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.

People and their relatives were satisfied with the service. They said they felt safe in the presence of care workers. They told us that care workers respected their choices and allowed them freedom and that privacy and dignity was respected. They gave us examples where care workers had demonstrated these qualities. They also said the food at the home was good and we found that people received appropriate support in this regard.

Records showed that the provider had involved family members, friends and health professionals in best interest meetings for people who had been assessed as not having the mental capacity to make certain decisions about their care and support. Where it was felt that people were being deprived of their liberty, the provider complied with the Deprivation of Liberty Safeguards (DoLS).

People received their medicines in a timely manner and staff completed Medicine Administration Record (MAR) charts appropriately. Regular audits also took place which helped to ensure medicines practice was safe. However, we saw that some bottles and creams were being used past their recommended shelf life from when they had been opened. Some people had their medicines crushed before taking them, we found that although authorisation from the GP were held in people’s records, there was no evidence that the pharmacist had approved the crushing of medicines. This was highlighted to the registered manager who sought this authorisation immediately.

Standard risk assessments to monitor people at risk of malnutrition, falls and skin integrity were in place and reviewed regularly. If any areas indicated a high risk there was an associated care plan in place to manage the risk.

Each person was allocated a named nurse. The process of nursing care was clear and comprehensive and comprised of a thorough assessment, planning, implementation of care plan and monthly evaluation. Records showed involvement of people, their relatives and health care professionals. People’s healthcare needs were met by the provider. Care records included people’s medical histories and observations. Daily record charts documenting any visits from doctors, nurses, and any other professionals were maintained.

Care workers were familiar with safeguarding procedures and the steps they would take to protect people that were at risk of harm or abuse. They told us that they felt supported and praised the quality of the training they received. Records showed they received regular training and supervision.

We found that staff recruitment procedures were not always robust. Although staff files included completed application forms, references, proof of identity and address and criminal background checks, we saw some examples where gaps in employment history were not explored and some references were not verified. We have made a recommendation to the provider regarding the use of more robust recruitment procedures.

The provider had systems in place to monitor the quality of service. These included monthly reports from a regional manager, mealtime observations form the registered manager and audits such as infection control and medicines.

We undertook this focussed inspection to check that they had followed their plan and to confirm that they now met the legal requirements in relation to the breaches found. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Pines Nursing Home on our website at www.cqc.org.uk.

The service had a manager in post who had completed the application to become the registered manager. 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.

The Pines Nursing Home is a care home with nursing, providing nursing care and support for up to 50 people. It is located in Putney, in the London Borough of Wandsworth. There were 30 people using the service at the time of our inspection.

At our previous inspection we found that risk assessments and care plans were not always updated when people’s needs changed and we found that consent to care and treatment was not always clearly documented.

At this inspection, we found that improvements had been made in all of these areas.

Appropriate checks were in place which helped to identify risks to people and care records showed that risks to people were regularly assessed and managed appropriately.

Specific risk assessments were in place and they were reviewed on a monthly basis. Any high risk areas identified had relevant assessments, care plans, a plan of care to guide staff and other monitoring records which helped to manage the risks to people.

We did see some examples where staff had incorrectly scored some of the risk assessments tools. Although there was minimal impact as the management of the risk was not affected by this.

Mental capacity assessment forms were in place and they were specific to particular areas such as maintaining a safe environment, personal hygiene, manual handling and health promotion. Where people did not have the capacity to consent, best interests care plans were available and best interests meetings had taken place which helped to ensure their rights were respected.

Records were in place documenting the level of involvement of family members and how often they wished to be involved in care plan reviews and how often they wished to be kept up to date.

Individual preferences questionnaires were completed for people asking them for their preferences in relation to how they liked to be supported, this allowed for a more person centred level of care to take place.

Care records were arranged logically and each identified risk had relevant risk assessments, care plans and plan of care in place. Records were updated monthly.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Staff were aware of procedures to follow if they felt people were at risk of harm. People using the service and their relatives told us they had no concerns about their safety, or the safety of their family member. Although people were being cared for in an environment that was safe some parts of the home were not cleaned appropriately. These were highlighted to the provider during the inspection who took immediate action.

Is the service effective?

Relatives told us that staff involved them in care plan reviews. Care plan reviews were undertaken by a nurse and, people using the service had a key worker assigned to them.

Is the service caring?

People who used the service told us "it's like home here", "staff are nice" and we are well looked after." Relatives told us there was a "great atmosphere" at the home and they had been "involved in discussions" regarding their relatives care and treatment. We observed an activity taking place and saw that people enjoyed it and were engaged.

Is the service responsive?

Where people did not have the capacity to understand decisions relating to their care we saw that best interest meetings were held to protect their rights. People using the service had access to a G.P and other healthcare professionals if the need arose.

Is the service well-led?

The registered manager conducted a number of audits around the home and had taken steps to involve people who used the service in the running of the home. People's complaints had been recorded and responded to. Staff that we spoke with generally felt supported by their colleagues and the manager.

We checked ten bedrooms and communal areas around the home. We saw there were thermometers in each room and regular temperature checks were carried out and recorded. The average temperature in the bedrooms was 23 degrees.

People we spoke with all felt their rooms were warm enough. One person said that their room was too warm and asked for a portable fan to help cool the room down.

An unannounced responsive inspection took place on the morning of the 27th November 2013.

We found that the majority of the home was warm but that some of the areas, bedrooms and bathrooms were cold or just warm. We found the hot water that we tested by touch to be hot.

We were told that during the weekend of the 23 ' 24 November 2013 the heating had partially broken down. Additional portable heaters were put in bedrooms and extra blankets and duvets supplied to people who used the service. The lounge area had an open fire that was lit.

The electricity power also failed because of the additional portable heaters being turned on. We were told by staff and residents that the power was off for only a few minutes.

During our inspection we spoke with residents who told us, 'It has been cold but I've got an extra blanket and a fire (portable heater)' and 'I went to the sitting room when it was cold'.

Before we left the home we saw an email dated 27 November stating that work on the heating would start on the week of the 2 December 2013 if not before. We asked the manager to tell us when the engineers start on the repairs and when the problems have been resolved.

We saw that staff treated the people using the service with dignity and respect. The staff we spoke with felt there were enough staff to provide care but more people would give them extra time to spend with people using the service. They also felt they had received enough training to enable them to do their job. One member of staff said that "The care given is good".

A person who used the service we spoke with said "I have received fabulous care".

The relative of the person who uses the service said that there was 'very good care' and the home 'could be top of the range'. The representative commented that 'the environment was very good' and 'I'm in regular contact with the manager who provides regular, clear updates on care'. A person using the service told us that the staff treated them with respect.

A member of staff said that she felt 'the home was not institutionalised' and 'had a nice atmosphere'.