Archived: Pine Lodge Care

We found the following examples of good practice.

¿ People were supported to stay safe when they met their friends and/or family members by meeting socially distanced for a short period of time. Large Perspex screens were used during visits to maintain social distancing. Alternative entrances to the home had been put in place, to ensure essential visitors were able to maintain social distancing and to reduce foot flow.

¿ People and staff members had individual risk assessments so that care, and support could be tailored to everyone’s individual requirement.

¿ Stocks of personal protective equipment (PPE) were readily available to staff and were used and disposed of correctly. Guidance on the use of PPE and current Infection Prevention Control (IPC) procedures were clearly visible across the service and available in picture format.

¿ Staff used a separate entrance and had a space to change into their uniforms upon starting and finishing their shift, to reduce the risk of cross infection.

¿ Specialist cleaning equipment had been purchased and was used to deep clean the environment. Items that were difficult to clean were sanitised effectively which reduced the risk of cross infection.

¿ Cleaning schedules had been increased and additional audits had been implemented to monitor cleanliness and staff compliance with the providers infection control policy.

Further information is in the detailed findings below.

Pine Lodge Care is a large detached building with support split between two units which are linked by a corridor. It provides care and support for up to 59 older people some of whom are living with dementia. There were 50 people living at the service when we visited. The service had some double rooms and some of these were shared by couples. People could choose if they preferred a shared room or a single one.

The service was run by a registered manager who was supported by an assistant manager, a head of care and a team leader in each unit. 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 previous inspection in May 2016 we found breaches of regulations. At this inspection improvements had been made and was compliant with regulations.

At the last inspection there had been a breach in regulation related to people’s nutritional needs not being met, advice from health care professionals not being recorded in people’s care plans and people’s weight not being recorded on a regular basis. At this inspection we found that all care plans included advice given by health professionals about how to support people to maintain a healthy weight. People’s weights were taken on a regular basis and any weight loss was reviewed. If required referrals were made to health professionals. A monthly review of people’s weights and any actions taken was completed by the registered manager.

At the previous inspection there had been a breach in regulation related to effective systems to monitor and improve the service and records not being completed fully or updated when required. At this inspection improvements had been made. Regular audits of the service, including care planning had been completed by the registered manager, assistant manager and an external assessor. Where shortfalls were identified these had been addressed and actions were recorded when completed.

At the last inspection we made recommendations about medicines and about pre-employment checks for staff. At this inspection we found action had been taken. Audits of medicines now included the review of PRN protocols and these were up to date and gave the information needed for staff to administer PRN medicines safely. The registered manager had carried out the necessary checks prior to staff starting work.

People and their relatives told us staff kept them safe. Staff understood different types of abuse they may encounter and were able to tell us what they would do if they were concerned. There were enough staff to keep people safe and staffing was adjusted by the registered manager based on the needs of people. Staff told us they had the support and training they required to meet the needs of the people they supported. People and their relatives told us, and we observed that the staff were competent and confident in their roles. Risks to people and the environment were assessed and plans were put in place to minimise the risks in a way which least restricted people. People’s medicines were managed safely and in the way they preferred.

The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). The registered manager had applied for DoLS authorisations in line with the legislation. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way. People’s care plans gave staff information about the best way to offer each person a choice, for example. ‘Only offer me a choice between two items as more may overwhelm me.’ Staff took time to give people choices and respected their decisions.

People told us they enjoyed the food, they were offered regular drinks and snacks throughout the day. People had a say in the menu via surveys and residents meetings. Requests had included a cooked breakfast and more green vegetables which had both been added to the menu. People’s food and fluid records were comprehensive and completed regularly. When people needed support with their health referrals were made to health professionals quickly. The service worked closely with community health teams such as the community matrons to improve people’s health and also to take part in trials of new systems aimed at meeting people’s health needs more quickly and efficiently.

People and staff had built positive and caring relationships. Throughout the day there was genuine affection between people and staff, with hugs and lots of laughter. Staff encouraged people to do as much for themselves as possible and offered reassurance if people were upset or anxious. People and their loved ones were involved in planning their care and regular updates. Staff treated people with dignity and respect at all times. Visitors were welcomed at the service and regular church services were held for people to attend if they wished.

The service used an online care planning system. People’s care plans were detailed and contained details of people’s lives before coming to the service along with what was important to them. Including details such as, ‘I like to have three pillows,’ and ‘I can only sleep if my room is completely dark.’ People who were living with dementia had a section in their care plan which detailed how staff should support them to live well with dementia. There was also clear guidance for staff around communication for each person. People had access to regular activities both in and out of the service. The registered manager was working with the activity co-ordinator to find new activities including new technology for people. People had access to sensory based activities such as ‘twiddle blankets’ which they found calming.

People and their relatives told us they knew how to make a complaint. Complaints were logged and all had been resolved to the complainant’s satisfaction. People and staff told us the management team were approachable and supportive. The management team including the registered manager often worked alongside staff providing role modelling and support. Everyone we spoke to knew that the visions and the values of the service were that the people they support are the priority. The registered manager sought out opportunities to work with other professionals to increase her knowledge and understanding of good practice. This information was used along with the results of any audits to improve the service and provide people with high quality care.

Pine Lodge Care is a privately owned care home that provides personal care for up to 59 older people, some of whom have dementia. The home occupies two connecting wings of detached premises, one wing is called The Firs and the other wing is called The Pines. There are two enclosed garden areas. The home is situated close to Sittingbourne town centre, with local shops, public transport and other community facilities nearby. On the day of our inspection there were 56 people living at the home

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.

People and their relatives were complimentary about the care and support provided by the service.

Recruitment practices were not always safe, gaps in employment history had not always been explored.

Medicines were accurately recorded and appropriately stored. Some people’s medicines records for PRN (as and when required medicines) were not up to date to evidence the medicines people were prescribed. We made a recommendation about this.

People were not always frequently weighed to monitor their weight. One person had been assessed by a community dietician following weight loss. The advice and guidance given had not been added to the person’s care plan, which meant staff would not know how to support the person effectively with their nutrition and hydration.

Effective systems were not in place to enable the provider to assess, monitor and improve the quality and safety of the service. Audits undertaken had not picked up the concerns about care records, staff recruitment records and inconsistent weighing. Records were not always complete, accurate.

Not all care plans included people’s life history and information to help staff get to know them, their preferences and life choices. We made a recommendation about this.

Staff had received training about protecting people from abuse and showed a good understanding of what their roles and responsibilities were in preventing abuse.

People’s safety had been appropriately assessed and monitored. Each person’s care plan contained individual risk assessments in which risks to their safety

There were enough staff on duty to meet people’s needs. Staff had undertaken training relevant to their roles and said that they received good levels of hands on support from the management team.

The premises and gardens were well maintained and suitable for people’s needs. The home was clean, tidy and free from offensive odours.

There were procedures in place and guidance was clear in relation to the Mental Capacity Act 2005 (MCA) that included steps that staff should take to comply with legal requirements. Staff had a good understanding of the MCA 2005 to enable them to protect people’s rights.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Deprivation of Liberty Safeguards (DoLS) applications had been made to the local authority and had been approved.

People were supported and helped to maintain their health and to access health services when they needed them.

Relatives told us that they were able to visit their family members at any reasonable time; they were always made to feel welcome.

People’s and their relatives were encouraged to feedback their views and experiences during meetings and through completion of surveys.

People were encouraged to take part in activities that they enjoyed. People were supported to be as independent as possible.

People and their relatives knew who to talk to if they were unhappy about the service.

Relatives and staff told us that the home was well run. Staff were positive about the support they received from the senior managers within the organisation. They felt they could raise concerns and they would be listened to.

Communication between staff within the home was good. They were made aware of significant events and any changes in people’s behaviour.

We found 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 this report.

During this inspection, we set out to answer our five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led? Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service and the staff told us. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

CQC monitors the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We spoke with the registered manager and they demonstrated their knowledge of the procedures to follow if an application needed to be made to deprive a person of their liberty at the home. We saw evidence that an application had been submitted following correct procedures and that proper policies relating to DoLS were in place. We saw evidence that all staff had been trained in DoLS, in the principles of the Mental Capacity Act 2005 (MCA) and in the safeguarding of vulnerable adults. We found that people's mental capacity was assessed and best interest meetings were held according to legal requirements. We found risk assessments with clear action plans were in place to ensure people remained safe.

Is the service effective?

People and their relatives told us they were satisfied with the quality of care that had been delivered. A relative of a person who used the service said, "I was involved straight away when my family member was unwell and needed more support". We saw that the delivery of care was in line with people's care plans and assessed needs. We found that the staff had received training to meet the needs of people living at the home. Staff received additional training when needed and when they requested it. Training courses included dementia, diabetes, palliative care, mental health and Parkinson's disease.

Is the service caring?

We found that the people who lived in Pine Lodge were supported by kind and attentive staff. We observed staff interacting with people who used the service and noted how staff provided encouragement, reassurance and practical help. Request for assistance were responded to promptly. We saw that staff showed kindness and patience when they supported people at mealtimes or during activities. A relative of a person who used the service told us, "They look after my family member very well, the care workers are patient and caring".

Is the service responsive?

People's needs had been assessed before they moved into the home and their support plans were reviewed regularly to reflect any change in their needs. We saw that people's records included their history, wishes and preferences and goals to be achieved. People and/or their representatives were involved with reviews of care plans and were kept informed of any changes.

A relative of a person who used the service told us, "They do quite a lot of activities here. My family member particularly enjoyed the last boat trip". We found that people had access to daily activities that included, but were not limited to, outings, theme nights, fashion days, read-aloud, quizzes, singing, live music, reminiscence and visits from the British armed forces. Daily activities that were requested by people who used the service were facilitated when practicable. People participated with the planning of menus and they told us, "The food is really good", "I am never very hungry but I enjoy a glass of wine or sherry with my meals, I get what I ask for".

Is the service well-led?

We found that comprehensive policies and procedures were in place that addressed every aspect of the service. The registered manager operated a system of quality assurance and completed audits to identify how to improve the service. When audits identified the need for an improvement, this was implemented. People and their relatives or representatives were consulted about how the service was run and annual survey questionnaires were sent and the results were analysed. Staff were regularly observed and monitored to identify whether additional training or refresher courses were needed. A member of staff told us, "There is an open door policy, we can walk in the office and talk with the manager when something is on our mind and we will be listened to".

People told us that they were happy with the support they received, and that the staff looked after them well. People said they liked the food, there was a choice of menu and that they chose where to eat. They told us they knew who to speak to should they have any concerns, but said they had no complaints. Comments from people that used the service included 'I have settled in well', 'Staff support me when I need assistance', 'The food is very good' and 'I enjoy the activities, there is a quiz this afternoon and I like quizzes'. One relative commented 'X has settled in well, she likes the staff and everyone is friendly and helpful'.

We made a compliance action at the inspection visit 1 November 2012 as people were not always protected against the risks associated with medicines because the provider did not have appropriate arrangements in place for storing and administering medicines. The provider wrote to us and told us what action was being taken to address these issues. We saw that the required changes had been completed at this visit.

Comments from people that used the service included 'I get up and go to bed when I want', 'The staff are very good, they are always there to help when I need assistance' and 'I like my room'.