Pinetum

We found the following examples of good practice.

Visitors were welcomed, and systems had been set up to facilitate this safely. On arrival visitors were asked to complete a COVID-19 test, have their temperature taken, complete a questionnaire, sanitise their hands and wear personal protective equipment (PPE) before coming into the service. One relative commented “They are very thorough but very kind and lovely with us.”

Relatives spoke positively about their experience of visiting their loved ones which they felt was safe. Visits took place in people's own rooms or in a 'visiting pod' that that was cleaned in-between visits and contained a full-length screen and a microphone to aid communication. Window visits and garden visits were also supported.

Relatives felt they had been kept informed throughout the pandemic and spoke highly of the communication they had received. They told us they received regular e-mails and telephone calls from staff to inform them of any changes in their loved one's wellbeing as well as any changes to the government guidelines. People were supported to keep in touch with their family using technology. Relatives confirmed staff supported their loved ones to receive face to face phone calls.

Appropriate procedures were in place to minimise the spread of infection and maintain people’s safety during the COVID-19 pandemic. Infection prevention and control (IPC) guidance was displayed so everybody was aware of the procedures in place, including visitors. The environment was clean and hygienic. Increased cleaning schedules, to reduce the risks of cross infection, were in place along with signage to indicate high touch areas that required additional cleaning.

We observed staff wearing the correct PPE and they knew how to dispose of it safely. People and staff were taking part in regular COVID-19 testing. People were being monitored for symptoms of COVID-19 and people who needed to, were supported to isolate in their own rooms. Staff were informed of who was isolating and knew what PPE to wear and what enhanced procedures needed to be followed to protect them from risk.

We were assured this service was following safe infection prevention and control measures to keep people safe.

Pinetum is registered to provide accommodation for up to 45 people who require nursing or personal care. The service is located on the Countess of Chester Health Park on the outskirts of Chester city centre and adjacent to the local hospital. At the time of the inspection there were 36 people accommodated.

People’s experience of using this service

People told us they were settled and happy living at Pinetum. They told us they got their medicines on time and staff supported them when needed.

Arrangements were in place for checking the environment to ensure it was safe. Some people living at Pinetum had been provided with nursing equipment to support their care which was regularly serviced and monitored.

The home was staffed appropriately and consistently. Most staff had been employed for several years and this helped to develop positive relationships with people living there. People told us that the regular staff had the skills and approach needed to help ensure they were receiving the right care.

People told us that they felt safe in the home. Nobody raised any concerns about the care; one person commented, “I’m comfortable with the way they do things for me” and another person said, “It’s very safe.”

There were a series of quality assurance processes and audits carried out internally and externally by staff and visiting managers for the provider. These were effective in managing the home and were based on getting feedback from the people living there.

The formal assessment and planning of people’s care in care records had been reviewed and updated. Records displayed good detail of people's care needs and evidenced their involvement.

There was a positive and relaxed atmosphere in the home. People living in the home interacted freely and the staff interactions we observed were seen to be caring and supportive. Given the wide diversity of peoples care needs, there was a good range of activities planned for people to engage in.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported.

People were supported to have 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.

We saw people’s dietary needs were managed with reference to individual needs and choice. Meal times provided a good social occasion.

Rating at last inspection:

The last rating for this service was Good (published 4 April 2017).

Why we inspected:

This was a planned inspection based on the previous rating.

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.

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

Pinetum is registered to provide accommodation for up to 45 people who require nursing or personal care. At the time of the inspection there were 38 people using the service.

The service is located on the Countess of Chester Health Park on the outskirts of Chester city centre and adjacent to the local hospital.

Pinetum had a registered manager in place. 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.

At the last inspection in March 2016 we found that a number of improvements were needed in relation to dignity in care, planning people's care and support, understanding capacity and consent and resolving concerns with the quality and safety of the service. We found the service in breach of Regulation 10,11 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered provider informed us they would be compliant with the regulations by 31 July 2016.

This inspection took place to establish what improvements had been made. We found that the registered provider had made the required improvements.

We observed at all times that people received personalised and appropriate care. People were treated with kindness, dignity and respect. Staff ensured that all reasonable steps had been taken to ensure the confidentiality of personal information.

Care plan documentation reflected a person's preferences as to how they would like their care and support to be delivered. Up to date information about people’s needs was readily available. Records reflected that appropriate care was delivered consistently. Checks on people's diet and fluid intake and repositioning were completed. Accurate information meant that the risk of inappropriate care and treatment was minimised.

People were supported to take their medications and the level of support people needed was assessed and documented. Medicines prescribed to people on an "as required basis" were given in a consistent manner and thickening agents were appropriately recorded and stored.

People's capacity was assessed under the Mental Capacity Act 2005 (MCA). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The registered provider had a system in place to monitor the quality, safety and effectiveness of the service. This highlighted where improvements were required and remedial actions were taken in a timely manner so that risks to people were minimised quickly.

People told us that they felt safe and cared for and their relatives echoed this. People lived in an environment that was clean and maintained. People and their relatives said that the registered manager was approachable and had made some improvements. Appropriate action had been taken in response to complaints made.

Staff were recruited in line with the registered provider’s procedure which was safe and thorough. This helped to ensure that people received care from staff that were suitable to do the job. New staff undertook an induction programme that included shadowing more experienced staff.

Staff received training and support appropriate to their roles. Staff also met on a regular basis to discuss issues of relevance, good practice, as well as wider developments in the service.

The views of people who used the service and their relatives were sought. Meetings were held where they could discuss issues with the management team. People also had the opportunity to participate in a wider survey conducted by the registered provider. This was to seek their opinion as to the quality of the service provided and to look at ways to improve.

Pinetum is registered to provide accommodation for up to 45 people who require nursing or personal care. It is located on the Countess of Chester Health Park on the outskirts of Chester city centre and adjacent to the local hospital.

Pinetum had a registered manager in place. 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 that whilst some aspects of the care and support were satisfactory, there were areas which required improvement and did not meet the regulations. You can see what action we told the provider to take at the end of the full version of this report.

Whilst we observed, at times, people received appropriate care, we also saw occasions where people were not treated with kindness, dignity or respect. There were occasions when staff did not ensure that all reasonable steps had been taken to ensure the confidentiality of personal information. This we deemed to be a breach of Regulation 10 of the Health and Social Care Act 2008.

Care plan documentation did not always reflect a person’s preferences as to how they would like their care to be delivered. Up to date information was not always readily available. Records did not reflect that appropriate care was delivered consistently. Checks on people’s diet and fluid intake and repositioning were not always completed. Inaccurate information meant that there was a risk that care and treatment might not be appropriate. This was a breach of Regulation 17 of the Health and Social Care Act 2008.

People’s capacity was not assessed under the Mental Capacity Act 2005 (MCA). We found care records did not consider people’s capacity to make decisions which meant there was risk their rights were not protected or that their care was compromised. This was a breach of Regulation 11 of the Health and Social Care Act 2008.

The registered manager had submitted a number of applications under the Deprivation of Liberty Safeguards (DoLS) but had not identified all care practices that could be deemed as restrictive. We therefore made a recommendation that the registered manager review the use of restraint and restrictive practice to ensure that they act in accordance with the MCA and DoLS were appropriate.

The registered provider had a system in place to monitor the quality, safety and effectiveness of the service. Although this had highlighted where improvements were required, we found that actions were not taken in a timely manner .This meant that this system was not effective in ensuring the risks to people were minimised quickly. This was a breach of Regulation 17 of the Health and Social Care Act 2008.

We found that people at Pinetum were being supported to take their medications. However, we found that some improvements were required to ensure that medicines that were on an “as required basis” were given in a consistent manner and that thickening agents were appropriately recorded and stored.

People spoken with and relatives told us that they felt safe and cared for. They lived in an environment that was clean and maintained. They said that the registered manager was approachable and that they had already made some improvements. We saw that there had been where complaints had been raised appropriate action had been taken.

The registered provider had ensured that staff responsible for recruitment had followed the appropriate recruitment checks. This meant that people were receiving their care from staff that had been thoroughly vetted to ensure they were suitable to do the job. New staff undertook an induction programme that included shadowing more experienced staff.

Staff received training and support appropriate to their roles. Staff also met on a regular basis to discuss issues of relevance, good practice, as well as wider developments in the service.

The views of people who used the service and relatives were sought. Meetings were held where they could discuss issues with the management team. Some people also had the opportunity to participate in a wider survey conducted by the registered provider. This was to seek their opinion as to the quality of the service provided and to look at ways to improve.

During inspections we routinely ask five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

We asked on this visit if the service is effective, safe, responsive, safe and well -led.

Is the service effective?

The service was effective

We found that people provided consent to their treatment as well as their personal arrangements to be made in the event of their deaths. We found that the care and welfare of people was promoted by the provider. We found that the nutrition and hydration needs of people were met.

Is the service safe?

The service was safe.

We saw that staffing levels at night met the needs of the people who used the service. We saw that staffing levels were maintained during the day and that staff were able to meet the needs of people. We also saw from staffing rotas that night staffing levels were maintained.

Is the service responsive?

The service was responsive.

We observed care being given and found that people were treated in a respectful and dignified manner at all times. We observed that staff took the independence of people into account; particularly in respect of eating. We saw that staff carried on their work in a manner which was carried out in a responsive manner.

Is the service well led?

The service was well led.

Since our last visit, the service had tightened up on the way it measured the quality of the care it provided. Audits from the manager and actions from visits by the registered provider had now been completed.

We spoke to two relatives. One told us that their relation had only just come to live at Pinetum. They told us that they had been able to contribute to the assessment information of their relative during their admission. Another relative told us that they were generally happy with the care provided and felt that their relative's health was getting better.

Is the service safe?

The expert by experience spoke with six people who lived at the home and they all reported that they felt safe in the home. The expert by experience also spoke with five relatives who were visiting and considered that their loved ones were safe.

Two care staff who were working on the high dependency unit told us about the additional training they had received in order to support people who used ventilation equipment. They had good knowledge of the equipment that was in use and the needs of the individual.

One person we spoke said that there were two members of staff who they felt afraid of and who had refused to provide the care that they required. Immediate action was taken by the person in charge to ensure that these allegations would be investigated appropriately and the person protected.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We looked at maintenance records and saw that safety checks had been carried out for gas, electrical circuits, portable electrical appliances, passenger lift and hoists, fire alarm and emergency lighting. Regular fire drills took place and the maintenance person carried out fire checks.

We saw that there were key pad locks on the staircases to keep people safe and secure however, the provider may find it useful to note that there was no lock on the passenger lift. The lift was situated opposite the main entrance door which was sometimes left open in warm weather. There was no risk assessment in place for this. There was a risk assessment folder which covered areas including the control of substances hazardous to health, and the management of slips, trips and falls however, the provider may find it useful to note that this contained only very basic information and did not give full guidance to staff on managing these hazards.

Is the service effective?

A relative who spoke with the expert by experience said 'People are well looked after.' and a relative we spoke with by telephone said 'I am extremely happy with the care.' Staff we spoke with considered that there was sufficient time for people to receive support with personal care as planned and when needed.

The expert by experience observed an art group supported by two members of staff . Staff interacted positively with the people who were participating and there was a friendly and cheery atmosphere. The people who spoke to the expert experience said they really enjoyed it and some of their work was displayed.

Care records showed that where there was a concern about a person's health needs such as their nutrition, risk of falls or pressure area care, the advice and support of medical professionals including dieticians, GPs and specialist nurses had been sought.

We looked all around the building and found that it was clean and adequately maintained. Some people had personalised their bedrooms with their own belongings brought from home. There were a sufficient number of toilets and assisted bathrooms.

Is the service caring?

People who spoke with the expert by experience said that staff treated them with respect and dignity, and were kind and caring. One person said 'The bulk of staff are kind and helpful.' and another person said 'Staff are very good, kind and caring.' A relative who was visiting said 'Staff are kind and caring, couldn't ask for a better place.' A person who lived at the home told us 'These ladies are perfect.' The expert by experience commented: 'During the day I observed staff being very patient, respectful and caring with the residents.'

Is the service responsive?

The care plans we looked at showed how the needs of the people who used the service were to be met, including the management of any identified risks to their well-being. A person we spoke with said they were getting the care and support they required and staff were available when needed.

A nurse we spoke with said that a number of people had swallowing difficulties. A dietician and a speech and language therapist were closely involved with a number of people's care and reviewed their care. We spoke with the chef who said that menus were being revised following input from a dietician and the people who lived at the home. Following advice from a dietician, he had been fortifying meals to make them more calorific.

Prior to our visit, we had received a concern that the building was excessively hot. The acting deputy manager was aware of this and told us that this had occurred during a period of very hot weather. She told us about measures that had been taken to ensure that people who lived at the home were kept comfortable.

A 'Quality and Governance Support' visit in April 2014 identified that a number of rooms did not have call bell extension leads for people to use. The home's maintenance person told us that the call bell system was obsolete and replacement parts were no longer available. A new call bell system had been ordered and the re-wiring work required had been carried out, however there was no date confirmed for the system to be installed. We were assured that all of the people who were able to use a call bell had access to one.

Is the service well led?

The home had a registered manager who had been in post for several years. We were informed that the home had been without a deputy manager for several months. A member of staff told us 'The provider is good to us and the manager is supportive.'

A 'manager self-audit schedule' on the noticeboard showed that audits of various aspects of the service were planned to be carried out each month of the year. However, there was no evidence to show that these had been carried out. A representative of the provider had carried out a 'Quality and Governance Support' visit in April 2014 and produced a report, however we did not see records of what actions had been taken as a result of the report.

People told us that there was a significant problem with staff sickness levels that needed to be addressed. One member of staff said "We have plenty of staff but attendance is appalling." We found evidence that staff had not received one to one supervision over recent months.

People who used the service told us they were happy at Pinetum and had no concerns with the care and treatment provided. They also told us they received their medication in a timely manner. Comments from them included: 'They are wonderful. I like to be independent and staff help me to do that', 'The staff are very nice and helpful. They are a wonderful crew', 'They (the staff) are brilliant. I know I'm looked after' and 'Nothing is too much trouble for the staff. They are very friendly.'

We found that the equipment the service used such hoists, slings and bed rails were in good working order. We looked at certificates that verified the service were compliant with Lifting Operations and Lifting Equipment Regulations (LOLER) 1998.

From our observations and discussions with staff we found the service had enough qualified, skilled and experienced staff to meet people's needs.

We found that people who used the service and / or representatives were asked for their views about the care and treatment that was received and they were acted on. There was evidence that learning from incidents and investigations took place and appropriate changes were implemented.

'It's an excellent service. The staff are friendly and give me the help I need.'

'I feel lucky to be here. It's a really good service.'

We spoke to three relatives who told us that they were happy with the care and support provided.

We received feedback from two health care professionals who reported that people were well supported at the service.

Records showed that people had been assessed before they began to use the service and they had a care plan in place detailing the support they needed and how staff were to minimise risks to their well-being.

There were practices in place to ensure that the recruitment of staff appropriately supported the people who used the service.

The home was clean and there were procedures and training in place to promote good hygiene and prevent infection.

There were systems in place to obtain the views of the people who used the service and their relatives about how the service operated.

Cheshire West and Chester Council had been involved in investigating some concerns that had been raised about the home within the last twelve months. They found that the home had taken appropriate action.