The Pines

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

Systems were in place to keep people safe. Risks were assessed and mitigated as far as possible. Incidents and accidents were reviewed and monitored and lessons were learned when things went wrong. People were supported with their medicines safely. The environment was visibly clean and well maintained. Staff were provided with training they needed to meet people’s needs safely.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Incidents and accidents were reviewed, monitored and measures were put in place to help prevent them happening again. The regional director told us about how the service was monitored, including reviewing documentation and receiving feedback from staff and people who used the service, which reduced the risks of closed cultures developing. They also told us as well as lessons learned within the service, any lessons learned within other locations were shared across the organisation and these were disseminated to staff to reduce future risks.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The manager told us how documentation was in place about people’s specific needs and important information about the person, which could be shared with other professionals, for example should the person need to be admitted to hospital. This was confirmed in records.

The manager told us about the support provided to people when they moved into the service from other placements. This included an assessment of their needs and visits to ensure the person’s needs could be met. People and their representatives, where appropriate, were included throughout to ensure their transition was smooth.

People were supported to understand their care and treatment needs. Where people required treatment in services in the community, staff supported people to prepare for their appointments to reduce anxiety.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Staff had received training in safeguarding and understood their roles and responsibilities in reporting concerns of abuse. There was a whistleblowing policy and procedure in place, and staff told us they understood this and would report any instances of bad practice as required. A staff member said, “I have been trained in safeguarding and know how to identify and report abuse. I am also familiar with the provider’s whistleblowing procedure and feel confident using it if necessary.”

Where any restrictions of people’s liberty were in place to keep them safe from harm, such as going out into the community alone, the service had raised Deprivation of Liberty Safeguards to ensure these restrictions were lawful. Support had been provided to reduce these restrictions, such as a person was being supported to access public transport by staff with a goal to use it independently when they felt confident and it was safe to do so, which was confirmed by the person who told us about their goals. The manager told us staff did not use physical restraint to restrict people.

People told us they felt safe living in the service, where there were potential conflicts between people, we observed staff quickly identified this and diverted people to reduce escalation. A relative said, “I do have peace of mind that [family member] is safe."

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People’s records showed how risks were being assessed in their daily living and measures were in place to guide staff in how the risks were mitigated. The records showed people were supported to understand the options available to them to support them in making informed choices where they may place themselves at risk of harm. For example, a person was independent with taking their medicines and they had agreed for staff to monitor the medicines to reduce risks, this was confirmed by the person. Where people required support to make decisions, these were discussed in their ‘circle of care’ with the involvement of others important to them, such as relatives. People were supported to identify goals and plans were in place to help them achieve them. A person told us how they chose what they wanted to do and they were supported to make plans with the staff, this included how they could do their chosen activity safely.

Where people had been assessed at risk of choking, appropriate referrals were made, for example to the Speech and Language Therapist (SALT) and guidance was being followed to reduce risks. The manager told us how a person was not happy with their food being cut into small pieces, such as a sandwich, where they did not feel it was a sandwich. The manager and staff were working with the person to support them to recognise the risks and accept the guidance provided. This included a trial of ‘reconstructing’ the sandwich after it had been cut. We observed this in practice.

We noted where a person used a thickener for their fluids, this was kept securely in the service to reduce the risks of people accessing it.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Since our last inspection, there was an ongoing programme of redecoration and refurbishment in the service. People told us how they had been consulted and chose the décor and furnishings. A person took us around the area where they lived, including the shared areas and told us about the plans for redecoration. Another person showed us their bedroom and told us how they had chosen the décor in their bedroom, “I picked everything.” This was confirmed by the manager who told us people were consulted in every aspect of the refurbishment. The manager told us how there were further plans for making the grounds more accessible, such as raised flower beds so people could plant in them. A person told us about the secured area which split the garden from the car park which was to keep people safe.

There were adaptations, such as raised toilets to support people to access them. Window restrictors were in place to reduce the risks of people falling out of windows and larger furniture such as wardrobes were attached to the wall to prevent them falling onto people.

People were safeguarded in the environment due to regular checks being made in areas such as fire safety, mobility equipment and the risks of legionella developing in the water system.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The manager told us a baseline of staff was in place each day based on the support and dependency needs for people. The manager was able to have more staff in shift to support, for example, people’s activities in the community and planned outings. This meant the staffing levels were not restricting people’s choices and access to the community, we observed people went out into the community for social activity during our inspection. The management team told us staffing levels were under continuous review, and where needed would be increased. People told us the staff were available when they needed them. A person said, “I ask [staff] when I need anything and they help.” We observed staff were attentive to people’s needs and any requests for assistance were promptly addressed. A relative said, “There’s always plenty of staff in the resident’s areas.”

The manager told us agency staff were used as a last resort, using existing staff where possible for example to cover short notice absence. This was to reduce the risks of people being supported by staff who they did not know and to support continuity of care. Staff vacancies were actively being recruited to, in addition, the manager told us they were hoping to employ some bank staff.

The provider completed recruitment checks of potential new staff in line with current legislation. Staff were provided with an induction when they were employed which included training. During the probation period, staff were receiving monthly supervision meetings where they could receive feedback, discuss concerns and identify any further training needs.

Staff had the training they needed to support people safely and effectively and their competency in relation to their training was reviewed regularly, this included in regular one to one supervision.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The service was visibly clean and hygienic. Infection control and prevention (IPC) were undertaken, which supported the management team to identify any shortfalls and address them. A person told us how they felt the home was always clean and they kept their personal space clean with staff support.

Personal protective equipment (PPE), including gloves and aprons, were available and used by staff as required. Staff received training in IPC.

People’s care records included specific support they may require reducing the risks of cross infection, such as prompting people to wash their hands after using the toilet if they had forgotten.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

People felt involved in their care and were supported in ways that promoted their independence, dignity, and personal choice. They received their prescribed medicines as intended and were supported to self-administer or apply their medicines, including creams, where this was assessed as safe and appropriate.

Topical medicines were recorded appropriately, with clear body maps in place to guide application. Risk assessments for people using emollients had been completed, with actions in place to reduce the risk of fire.

Detailed, person-centred guidance was in place for 'when required' (PRN) medicines, such as pain relief. This included clear instructions on when and how to administer medicines based on individuals’ needs and behaviours.

Staff received the necessary training, and their competence was assessed regularly. They worked closely with other healthcare professionals to ensure people’s medicines were reviewed regularly.

Regular medicines audits were carried out to ensure systems remained safe. Medicines-related incidents were reported and investigated, with actions taken to reduce the likelihood of these happening again.