Archived: Pinewood Rest Home

Pinewood Rest Home is a residential care home providing personal care to 11 people aged 65 and over at the time of the inspection. The service can support up to 16 people, some of whom may be living with dementia.

During this inspection we carried out a separate thematic probe, which asked questions of the provider, people and their relatives, about the quality of oral health care support and access to dentists, for people living in the care home. This was to follow up on the findings and recommendations from our national report on oral healthcare in care homes that was published in 2019 called ‘Smiling Matters’. We will publish a follow up report to the 2019 'Smiling Matters' report, with up to date findings and recommendations about oral health, in due course.

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

Environmental risks were not always managed effectively; Staff did not have regular fire evacuations to keep people safe. Fire systems were not always tested in line with best practice.

Relevant recruitment checks were not always safe. For two staff members application forms were not fully completed which meant the service could not check the staff members employment history to make sure they were of good character and had the necessary skills.

We were assured that most infection prevention and control practices were in line with current guidance. However, some improvements were required.

Governance systems were not always effective in promoting a person-centred culture. A new manager was in place and was working to ensure new systems were in place and effective and was getting to know people at the service.

Systems were in place to protect people from abuse. Staff we spoke to were aware of how to identify, prevent and report abuse. There were enough staff to keep people safe.

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.

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 27 August 2021)

Why we inspected

We received concerns in relation to falls equipment and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to risks to fire procedures and staff recruitment practices at this inspection.

Follow up

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

About the service

Pinewood Rest Home is a residential care home providing personal care to 12 people aged 65 and over at the time of the inspection. The service can support up to 16 people, some of whom may be living with dementia.

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

People felt safe. Staff had received training in safeguarding and understood the actions they needed to take if they identified any concerns. Systems were in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and assessments. Effective infection prevention and control procedures were in place and a range of audits were carried out by the registered manager and senior staff.

A range of healthcare professionals, including community nursing and mental health teams, were involved in people’s care when necessary. People received personalised care in line with their assessed needs and their care plans. Risks were assessed and actions taken to minimise these while promoting independence as far as possible.

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 were supported by staff who had received a thorough induction into the service and appropriate training, professional development and supervision to enable them to meet people’s individual needs. People were supported to have enough to eat and drink and there was a range of food and drink to choose from.

The service was responsive to people’s needs and staff listened to what people said. People were confident they could raise concerns or complaints and that these would be dealt with. People and their families or other representatives were involved in discussions about their care planning.

The registered manager promoted an open and inclusive culture within the service, and governance systems were focused on safety and quality improvement. There was a homely atmosphere in the service and staff understood the value of person-centred care. The provider and registered manager had continued plans for improvements to the service, including planned improvements to the building and environment.

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 requires improvement (published 14 May 2019) with no breaches of regulation. The rating of requires improvement was a reflection of the need for continuing and sustained improvement to make sure the new working practices and management culture were firmly embedded. At this inspection we found improvements had been sustained.

Why we inspected

This was a planned inspection based on the previous rating.

This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which were the areas that required improvement. The rating from the previous comprehensive inspection for the key question not looked at on this occasion was used in calculating the overall rating at this inspection.

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.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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.

People’s experience of using this service: The new manager had introduced an open, inclusive culture and ethos, which people, staff and external professionals spoke positively about.

At this inspection we found the new manager and the registered provider had made substantial improvements in the standard of care provided at the home. They were compliant with the fundamental standards set out by law although further actions were required to embed good working practices in the home.

Staff training was being reviewed and rescheduled where necessary, due to a lack of records of training completed. A supervision plan was in place and the manager was carrying out spot checks.

Ongoing improvements were being made regarding obtaining consent to care and support.

Improvements were continuing to be made to the premises / home environment.

Care plans were being reviewed and re-structured to improve personalisation, accuracy and accessibility.

The new management team were starting to improve and develop new systems for monitoring the safety and quality of service.

Improvements had been made in the way people’s medicines were managed and audits were carried out and recorded. There was a new facility for storing people’s medicines.

Staff understood the procedures for keeping people safe from harm or abuse.

People were supported to eat and drink well and the quality and choice of food had improved.

People were supported to maintain their mental and physical health and the service was working in partnership with external professionals.

Staff were friendly and caring and treated people with respect. There was a person centred team approach resulting in positive outcomes for people.

Staff demonstrated a good knowledge of people’s individual needs and preferences regarding their support. People were encouraged and supported to express their needs and wishes. Any concerns were listened to and followed up appropriately.

Rating at last inspection: Requires Improvement (report published 12 February 2018). This service has been rated Requires Improvement at the last two inspections.

Why we inspected: This was a planned inspection based on the rating of the service at the last inspection in November 2017.

Follow up: Going forward we will continue to monitor this service and plan to inspect in line with our re-inspection schedule for those services rated Requires Improvement. If any concerning information is received, we may inspection sooner.

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

Pinewood Rest Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Pinewood Rest Home provides accommodation and personal care for up to 16 older people in one adapted building. The home does not provide nursing care. There were 12 people using the service at the time of this inspection, some of who were living with dementia.

The service had a 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.

At the last inspection of this service in August 2015 we found that the systems in place to assess, monitor and improve the quality and safety of the service were not always operated effectively.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question Well Led to at least good.

At this inspection we found that some improvements had been made. The registered manager had implemented more comprehensive audits and the provider had made improvements to the home environment. However, the quality assurance systems were not robust and did not identify shortfalls in records and training. There was not a culture of continuous improvement and learning in the service. Service development planning needed to be introduced and for the registered manager to update her knowledge about the regulations and legislative framework.

Staff had not all received a comprehensive training programme, supervision and appraisal to support them to meet the needs of people living in the service.

The procedures and guidance for staff for the administration of ‘as required’ medicines were not safe so there was a risk of people not receiving their prescribed medicines, or receiving them inappropriately.

The procedures for obtaining consent to care and treatment did not reflect current legislation and guidance. There was a lack of understanding about who could consent to care being provided. Although the registered manager was aware of the need to apply for Deprivation of Liberty Safeguards (DoLS), this had not always been done appropriately.

People’s care records were not always up to date, relevant and accessible and did not evidence how people were involved in the process.

Quality assurance systems were still not robust and consistently applied in order to assess, monitor and improve the quality and safety of the service.

The system for ensuring all recruitment information was readily available to support the provider and registered manager to make safe recruitment decisions was not always effective.

There were sufficient staff deployed.

The majority of people we spoke with told us they always enjoyed the meals. People received appropriate support to eat and drink enough to meet their needs.

People were referred to other healthcare services when their health needs changed.

Staff respected people’s privacy and dignity and were responsive to their needs, choices and preferences.

People spoke positively about the service, staff and registered manager. There was a person centred culture at the home. Staff had positive caring relationships with people and supported them to make choices about their care.

People and relatives we spoke with told us they had no complaints and were comfortable to raise any concerns if they had them.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We found there were effective procedures and systems in place for cleanliness and infection control, and people were cared for in a clean and hygienic environment.

We also found the provider had addressed the issues we had identified previously regarding the safety and suitability of the premises. Essential maintenance had been carried out and the home had been redecorated.

The service took steps to ensure people were asked for their consent before they were given care or support. Where people lacked capacity to consent, the provider followed legal requirements to safeguard their rights. Care and support was planned and delivered in a way that was intended to ensure people's welfare. Care plans were detailed and person-centred, and supported staff to meet people's different needs. Staff were observed to to be respectful and responsive to those different needs.

We found a number of significant issues concerning infection prevention and control, and have told the provider to make sure these issues are addressed quickly and in full.

We found the building was poorly maintained, which had resulted in premises that did not adequately support people's health and well-being The provider had not taken the necessary steps required to protect people against the risks of unsafe or unsuitable premises.

The provider had in place effective recruitment and selection processes, and appropriate pre-employment checks were undertaken. This meant people were cared for by suitably qualified, skilled and experienced staff.

People were listened to and their comments and complaints were responded to appropriately.