Pinelodge Care Home

Pinelodge Care Home is registered to provide accommodation, nursing and personal care to up to 140 people. The service is a single purpose-built building, divided up into five units. At the time of the inspection, 106 people were living there.

We found the following examples of good practice.

Visitors were being received at the service with infection control procedures in place. Visitors were provided with personal protective equipment (PPE) and had their temperature checked by staff on arrival. There was clear guidance and signage throughout the service to prompt and remind visitors of the measures to adhere to.

Isolation, cohorting and zoning had been successfully implemented. Staff were allocated to work within one unit in the building, wherever possible. There was a staff room in each unit which provided a preparation area for them on arrival to and departure from the service. Each unit also had separate communal facilities such as lounges and dining areas for people, which enabled it to be self-contained.

PPE was available at designated stations throughout the building so that staff could easily access equipment wherever they were assigned to work. Staff were seen to be adhering to the PPE guidance and protective measures in place.

Risks to people in relation to their health, safety and wellbeing had been assessed. Each person had a ‘Covid-19 Management Care Plan’ that provided clear guidance for staff as to how each person should be supported, if they were to test positive for COVID-19.

Regular checks of the environment and staff practice were completed by management, alongside infection prevention and control audits.

We found the following examples of good practice.

¿ People were supported to keep in touch with friends and family virtually.

¿ The provider had developed policies, procedures and risks assessments for managing the service in relation to COVID-19.

¿ People and staff had engaged with the routine testing scheme. Where people received a positive test result for COVID-19, they were supported to isolate in their bedrooms for a period of 14 days. Staff were clear on what it meant to isolate and what symptoms of COVID-19 to look out for.

¿ Staff had received training on donning and doffing personal protective equipment (PPE), infection control and COVID-19. They had their competency assessed. They told us they had enough information to do their jobs safely. All staff we spoke with were clear on what processes were in place and why they were needed.

¿ Staff told us that the registered manager had been very supportive and gave clear leadership during difficult times.

People’s experience of using this service:

The recruitment process was not robust. For example, full employment history had not always been taken and references not always verified to satisfy themselves that the person was fit to work in a care setting. People’s view on staffing varied, as did the staff team’s feedback. Staff hours were assessed in accordance with a dependency tool which calculated the number of hours of support people needed. There were systems in place to help ensure staff were trained and received regular supervision. Staff felt supported.

There were areas of the home that were in need of repair and refurbishment. There were plans to complete this work. However, bathrooms and communal toilets posed an infection control risk and did not make the bath or shower time experience pleasant.

People had their individual risks assessed and staff were aware of these. People were supported safely. People received their medicines when needed. People’s personal care needs were met and the internal monitoring showed a reduction of falls, weight loss and pressure ulcers. This indicated care was delivered in accordance with people’s assessed risks.

The provider had systems in place to help them identify and resolve any issues in the home. Many of the issues found on inspection had been identified through this process.

People were happy at the service and were supported by staff who knew them well. People felt privacy and dignity was promoted. People were able to choose how to spend their time and encouraged to make decisions about their care. People’s care plans included information that gave staff information on how to support people.

People told us they enjoyed the activities available. People had the opportunity to go out. Staff needed to be reminded to ensure everyone was given the opportunity to join in with activities each day and to communicate to people what was on offer. There were communal areas such as a tea room, pub and library. They were all used on the day of inspection, but staff told us they were typically used once a week.

The registered manager was well known throughout the home and people and staff were positive about them. All staff were clear about what was expected of them and the plans for the service were shared with them, along with any lessons learned from events or incidents.

The service met the characteristics for a rating of "Requires improvement" in two key questions and met the characteristics for a rating “Good” in three key questions.

More information about our inspection findings is in the full report. Please see the action we have told the provider to take’ section towards the end of the report

Rating at last inspection: At the last inspection the service was rated as requires improvement, with Well Led rated as inadequate. There were breaches of regulation. At this inspection we found that well led had improved it’s rating to requires improvement and the number of breaches had reduced.

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

We asked the provider for monthly updates on the progress of the refurbishment plan. We will continue to monitor the service to ensure it provides safe and effective care. We will plan further inspections in the future.

Pinelodge Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodates up to 140 people in an adapted building. At the time of the inspection there were 120 people living there.

The service had a manager who was registered with the Care Quality Commission (CQC). 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 and associated Regulations about how the service is run.

There were systems in place to monitor the quality of the home. However, they had not identified the areas of concern that we found on inspection. However, people and staff were positive about the running of the home and the management team.

Most people were supported in a safe way. However, some assessments and processes did not always promote this. We also found that although there were systems in place to monitor medicines management, medicines were not consistently managed safely.

Staff knew how report any risks to people’s safety. However, fire safety needed to be reviewed to ensure staff knowledge was robust and infection control was not always promoted.

Feedback about staffing was mixed. Staff received regular updates to their training and were recruited safely.

Most people were supported in accordance with the principles of the Mental Capacity Act 2005. People gave mixed views about the food and the mealtime experience needed to be improved. The environment had some areas that needed to be addressed.

People told us most staff were kind, however some people told us other staff were not as kind. The service needed to ensure people’s dignity was always promoted and that people’s involvement needed to be consistently reflected in the planning of their care. Confidentiality was promoted with records held securely.

People did not receive care in a person-centred way and there were mixed views about the activities provided. There was a complaint’s process which people and their relatives knew how to use. However, not all issues or concerns were shared with the registered manager by staff.

You can see what action we told the provider to take at the back of the full version of the report.

Pinelodge Care Home provides accommodation and nursing care for up to 140 older people, including people living with dementia. At the time of the inspection there were 136 people living there.

The service had a manager who was registered with the Care Quality Commission (CQC). 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 and associated Regulations about how the service is run.

The registered manager was on annual leave at the time of this inspection however, the deputy manager demonstrated an in depth knowledge of the service, the people who used the service and the staff team. There were systems in place to monitor the quality of the service and these were being used effectively.

People told us they felt safe and individual risk assessments were in place. Staff were aware of how to promote safety and report any concerns. Accidents were reviewed to reduce the risk of a reoccurrence. People’s medicines were managed safely.

Staff were recruited safely, felt supported and completed regular training. There were mixed views about staffing levels. However, we observed that people had their needs met in a timely fashion.

People were encouraged to make choices and their consent was sought before care was provided. The staff worked in accordance with the principles of the MCA.

People were supported to eat and drink sufficient amounts and had regular, appropriate contact with health care professionals.

People were treated with dignity and respect. Staff had developed meaningful relationships with people and people told us they were kind. People were involved in planning their care and confidentiality was promoted.

People received care that met their needs and their care plans were clear and up to date. There were regular activities on offer which people enjoyed. People felt confident to raise concerns and told us that they would be addressed promptly.

At our previous inspection of Pinelodge on 22 May 2014 we found that people were not protected from the risk of infection because appropriate guidance had not been followed. We judged this to have a moderate impact on the people who use the service and we issued the provider with a warning notice.

At our inspection on 30 September 2014 we toured the environment to review the cleanliness and infection control practices in the home. We spoke with the deputy manager, two domestic staff members, six care staff members, one visiting health professional and one relative of a person who used the service. All staff members that we spoke with confirmed to us that they had undertaken infection control training and were aware of the role in regards to the appropriate standards of cleanliness and infection control.

We saw that there had been significant improvements to the standard of cleanliness and infection control in the home. We viewed all areas of the building and found most areas to be clean, tidy and hygienic. Cleaning schedules and records were in place which demonstrated regular cleaning and monitoring of all areas of the home.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

People who used the service told us that they felt safe and cared for. For example, one person told us, 'We are well looked after. The nurses are good. The breakfast was nice. I am safe here and I have no concerns'. Another person said, 'I am quite well. I had a stroke and I am having eating lessons from the speech therapist. I have no complaints. Definitely, I feel safe. The staff are friendly and very caring. The food is not too bad. So I am well cared for.'

We saw that there were posters displayed throughout the communal areas of the home informing people how to report any concerns or suspicions of abuse.

Is the service effective?

We spoke with a mental healthcare professional who visited the home daily to provide specialist help and support to people who lived with significant dementia care needs. They told us, 'The dementia care needs of some people who live here are very high indeed. The staff manage their needs well.'

Is the service caring?

During our inspection we saw that staff treated people with respect and kindness while delivering appropriate levels of care and support.

Is the service responsive?

At a previous inspection of this service on 11 April 2014 we found that people were not protected from the risk of abuse because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. At our inspection on 01 and 05 August 2014 we found that the whistleblowing policy and procedure had been reviewed and that the guidance contained in the policy had been updated to support staff to disclose any concerns directly to appropriate authorities outside of the service.

Is the service well-led?

As part of our inspection we looked at care plans for eight people who used the service, six of whom had significant dementia care needs. We found that care plans provided information on how to support each person in meeting their needs. We saw that mental capacity assessments had been undertaken and that personal care had been delivered in accordance with the care plans and risk assessments.

However, at this inspection on 22 May 2014 we found the service had not made sufficient improvements in this area.

During this inspection we set out to answer our five key questions; is the service caring, responsive, safe, effective and well led?

Is the service safe?

Some areas in the home were dirty and unhygienic. We have told the service that this requires improvement as it posed a risk to people's health and welfare.

Is the service effective?

The service had not completed their action plan and staff were not consistent in completing tasks set by the manager.

Is the service caring?

The manager and the senior staff were committed to the home and told us they wanted to achieve a good standard of cleanliness for people.

Is the service responsive?

The service had not responded appropriately to the warning notice issued for the standard of cleanliness and infection control at the last inspection.

Is the service well led?

We found there were shortcomings in the overall monitoring of the service and this required improvement.

However, at this inspection on 11 April 2014 we found the service had not made sufficient improvements in this area.

During this inspection we set out to answer our five key questions; is the service caring, responsive, safe, effective and well led?

Is the service safe?

We saw that the service had plans in place for each individual in regards to an emergency. However, some of the staff we spoke with were not sure of people's full names so this may have impacted on these plans.

The service had a safeguarding policy and procedure in place and staff had received training in relation to safeguarding people from the risk of abuse. However, the policy and training encouraged staff to not report outside of the service and to raise concerns internally. The manager told us that they would address this straight away. People who used the service told us that they felt safe and that staff were easy to talk to.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Relevant staff had been trained to understand when an application should be made, and how to submit one. The manager told us that there were three people with an authorised deprivation of liberty document in place. These were for various reasons and the manager was well aware of the reason for them.

Some areas in the home were dirty and unhygienic. We have told the service that this requires improvement as it may have posed a risk to people's health and welfare.

Is the service effective?

Care plans were well written and clear. Care notes demonstrated that staff had a clear understanding of each person's needs. People we spoke with told us that they received care and support in a way that they chose.

Is the service caring?

People we spoke with told us that the staff were kind and caring. One person told us, 'It's a fantastic place and the staff can't do enough to make us happy and they look after us very well. The staff are very caring and gentle'.they all seem to know what they are doing.'

We observed staff interaction and this was evident most of the time. We did note that on occasions during lunchtime staff did not listen clearly or wait for a response from a person before removing their dinner plate.

Is the service responsive?

The service had not responded appropriately to the compliance action for the standard of cleanliness and infection control at the last inspection. However, we saw when a person's care needs changed, this was communicated through the staff team and the care plan was updated.

Is the service well led?

The manager was well supported by the deputy managers who were responsible for leading the team. The manager and the deputy managers were knowledgeable and were aware of the importance of leading your team well. The staff spoke highly of the manager and the deputy managers and told us that they felt it was a good service.

However, we found there were shortcomings in the overall monitoring of the service and this required improvement.

People's needs were assessed and care and treatment was planned and delivered in line with those individual needs. People who were living in the dementia unit experienced life enriching activities that met their social and emotional needs. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We found that there were appropriate risk assessments and support plans in place for each aspect of people's daily living routines and for behaviours which might be challenging.

People were not protected adequately from the risk of infection because several aspects of the environment presented significant infection control risks.

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

People were cared for by suitably qualified, experienced and skilled staff that had been properly recruited and vetted.

Accurate and relevant records about people living at the home were maintained. Records of people using the service and staff were kept securely.

We found that people or their relatives had been given information and had been consulted about the way that care and treatment was planned. People's independence was maintained and they were treated with dignity and respect. One person told us, "They always help you and they are always kind here. They will do anything for you."

We saw that people were cared for by staff that understood their needs. This was because their needs were assessed and care was planned according to those individual needs. One person said, 'It's very pleasant. Very pleased with the place. I like the atmosphere. I can't say anything bad about the place."

People were safe at Pinelodge because the provider took steps to identify the potential for abuse and responded appropriately when abuse was alleged.

The provider had an effective system for monitoring the quality of the service and for responding to any shortfalls.