Pinewood Nursing Home

Pinewood Nursing Home is a residential nursing home providing personal and nursing care to 26 people aged 65 and over at the time of the inspection. The service can support up to 30 people.

The home has 26 single rooms and two double rooms over two floors. People have access to a communal lounge, a dining room and a conservatory. Many rooms have an en-suite bathroom and access to the gardens. There are also shared bathrooms with fully accessible baths and showers.

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

Trained staff administered medicines safely. Since the last inspection there had been improvements to the medicines administration procedures. People were kept safe from the risk of abuse by well trained and caring staff. The home was kept in good safe repair and was clean and smelled fresh. Safety checks on equipment used in the home were carried out routinely. Staff were recruited safely and there were enough staff to support people and spend time with them. A staff member told us, “No one is ever rushed, they can take their time, for example when getting up in the morning. Christmas time was just lovely, we made sure everyone was involved."

People were looked after in a personalised way. Early assessment and frequent reassessment of the care people needed made sure staff were able to give people the care they required. A relative told us, “Since Mum has been here she has not fallen once, in over a year. The carers are caring and so mindful of Mum's needs.” Staff were well trained and enjoyed opportunities to do extra training beyond subjects considered essential for care. People were supported to eat and drink and had a balanced diet they enjoyed. People were able to cook with staff at the home. People were referred to outside healthcare agencies when necessary and staff supported people if they needed to attend appointments outside the home.

People at the home were treated with kindness by respectful staff. People could decide how to spend their days and although encouraged to take part in activities and not become isolated, they had the freedom to stay quietly in their rooms if they preferred. A relative told us, “The other day he didn't feel well and they asked him if he wanted to get up. He said no, so they gave him a duvet day. I couldn't come at the weekend but I rang up and the staff were lovely and told me not to worry. He's clean and tidy they look after him.”

People were supported to keep in contact with friends and family. The registered manager used a ‘wish book’ for people to write their ideas for things they hoped to do. These things could be simple, such as a trip to the beach, or more complicated, such as a trip to London to see a show. Photographs showed people’s wishes being fulfilled. The home ensured there were always activities for people to do if they wished, events were organised by a dedicated activities coordinator. Relatives and people felt able to raise issues with the registered manager and knew they would be acted upon.

The home was well led by a registered manager with support from the provider. Since the last inspection the registered manager had worked to address the issues around the medicine errors and things had improved. Regular audits of the service ensured issues or errors were spotted quickly and could be rectified promptly. Staff told us they were happy working at the home. People and their relatives told us the service was good, and the registered manager led the staff well. A relative said, “Staff are good at handling all situations. There have been no problems, I feel able to speak to people.” People were involved in decisions made at the home and there were regular residents’ meetings.

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 requires improvement (published 21 February 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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.

Pinewood Nursing Home is a care home with nursing for up to 30 people. On the day of our inspection there were 27 people living at the service. It specialises in care for older people who are living with dementia or have a physical disability.

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.

There was a registered manager in post. 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.

Some of the people who lived in the home had limited communication therefore we spent time observing people.

At the last inspection, on the 27 June 2018 the service was rated Good overall. However, it has now been rated now Requires Improvement in Safe and Well Led. This was due to medicines not always being managed safely and the monitoring of medicines not being enough to reduce errors.

People’s medicines were not always managed safely or properly. People did not always receive their medicines as they should, including pain relief medicines. Some medicines were given and not signed for while others were not given but signed for.

We had received a concern in June 2018 in relation to medicines management. As a result, we asked the registered manager to send us the outcomes of their monthly medicines audits. These showed that the medicines management had not consistently improved in the service. On the day of our inspection we found six errors had already occurred in the last 12 days (3rd January to 14th January 2019). Action taken when audits had highlighted errors had not been robust enough to sustain good practice.

People lived in a service which had been designed and adapted to meet their needs. The provider monitored the service to help ensure its ongoing quality and safety. The provider’s governance framework, helped monitor the management and leadership of the service. The provider had monitoring systems which enabled them to identify good practices and areas of improvement.

However, though audits were carried out, medicines audits showed a high number of medicine errors including people not receiving their medicines as prescribed. Actions they had taken to improve practice had not been successful and medicines errors were found to have continued.

The registered provider took further action during the inspection. This included again writing to all staff to arrange additional in-depth medicines training and a letter outlining the issues we found.

Staff had completed safeguarding training and updates were provided. Staff had a good knowledge of what constituted abuse and how to report any concerns. Staff understood what action they would take to protect people against harm and were confident any incidents or allegations would be fully investigated. Staff confirmed they’d have no hesitation reporting any issues to the registered manager or provider.

People were protected by safe recruitment procedures. This helped to ensure staff employed were suitable to work with vulnerable people. Staff confirmed there were sufficient staff to meet people’s needs. Staff had completed appropriate training and had the right skills and knowledge to meet people’s needs. Staff also completed an induction programme when they started and their competency was assessed. Staff were provided training appropriate to the people they cared for, for example dementia care. Staff also completed formal care qualifications which included equality and diversity training.

People’s risks were assessed, monitored and managed by staff to help ensure they remained safe. Risk assessments were completed to enable people to retain as much independence as possible.

People’s accidents and incidents were documented. People, when needed, had been referred to appropriate healthcare professionals for advice and support when there had been changes or deterioration in their health care needs. Feedback to assess and improve the ongoing quality of the service provided was sought from people living in the home, professionals and staff.

People lived in a service where the provider’s values and vision were embedded into the service, staff and culture. Staff described the registered manager and provider as being very approachable and supportive. Staff talked positively about their roles.

The registered manager and provider had an ethos of honesty and transparency. This reflected the requirements of the duty of candour. The duty of candour is a legal obligation to act in an open and transparent way in relation to care and treatment.

People lived in an environment that was clean and hygienic. The environment continued to be upgraded including new carpets and chairs.

People were supported to maintain good health through regular access to health and social care professionals.

People activities reflected their interests and individual hobbies. People were engaged in different activities, arranged by the activities coordinator. During our visit these included going out with family or enjoying the company of the visiting ‘Petting’ dogs.

People had access to snacks and drinks they enjoyed, while trying to maintain a healthy diet. People had input as much as they were able to in planning menus.

People’s care records were detailed and personalised to meet individual needs. Staff understood people’s needs and met them. People were not all able to be fully involved with their support plans. For example, due to living with dementia. Therefore, family members or advocates supported staff to complete and review people’s support plans in their best interests. People’s preferences were sought and respected. Care plans held full details on how people’s needs were to be met, taking into account people’s preferences and wishes. Information held included people’s previous history and any cultural, religious and spiritual needs.

People were observed to be treated with kindness and compassion by the staff who valued them. The staff, some who had worked at the service for many years, had built strong relationships with people. All staff demonstrated kindness for people through their conversations and interactions. Staff respected people’s privacy.

People’s equality and diversity was respected and people were supported in the way they wanted to be. People who required assistance with their communication needs had these individually assessed and met. People could make choices about their day to day lives. The provider had a complaints policy in place and records showed all complaints had been fully investigated and responded to.

People’s care and support was based on legislation and best practice guidelines, helping to ensure the best outcomes for people. People’s legal rights were upheld and consent to care was sought. The registered manager understood their role with regards to ensuring people’s human and legal rights were respected. For example, the Mental Capacity Act (2005) (MCA) and the associated Deprivation of Liberty Safeguards (DoLS) were understood by the registered manager. They knew how to make sure people, who did not have the mental capacity to make decisions for themselves, had their legal rights protected and worked with others in their best interest. People’s safety and liberty were promoted.

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. People's healthcare needs were monitored by the staff and people had access to a variety of healthcare professionals.

People’s end of life wishes were documented. People could be confident that at the end of their lives they would be cared for with kindness and compassion and their comfort would be maintained. The staff worked with other organisations to make sure high standards of care were provided and people received the support and treatment they wished for at the end of their lives.

We found two breaches of the regulations. You can see what action we told the provider to take at the back of the full version of the report.

There was a registered manager in post. 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 told us they felt safe with staff. Relatives had no concerns about the safety of people. There were policies and procedures regarding the safeguarding of adults and staff knew what action to take if they thought anyone was at risk of potential harm.

Potential risks to people had been identified and assessed appropriately. There were sufficient numbers of staff to support people and safe recruitment practices were followed. Medicines were managed safely.

Staff had received all essential training and there were opportunities for them to study for additional qualifications. Staff felt supported by the management, through supervision and appraisal. Staff monitored people’s health and took prompt action to address any concerns. People had access to healthcare professionals and appropriate referrals were made for guidance or additional support.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found the provider to be meeting the requirements of DoLS. We found the registered manager understood when an application should be made and how to submit one The registered manager and staff were guided by the principles of the Mental Capacity Act 2005 (MCA) regarding best interests decisions should anyone be deemed to lack capacity.

People were supported to have sufficient to eat and drink and to maintain a healthy diet. People’s rooms were decorated in line with their personal preferences.

Staff knew people well and positive, caring relationships had been developed. People were encouraged to express their views and were involved in decisions about their care as much as they were able. Their privacy and dignity were respected and promoted. Staff understood how to care for people in a sensitive way.

Care plans provided information about people in a person-centred way. People’s preferences and likes and dislikes were documented so that staff knew how people wished to be supported. Complaints were dealt with in line with the provider’s policy.

The registered manager was active in monitoring the care that people received and there were systems in place to monitor and audit the service. People, their relatives and staff felt able to raise issues or concerns with the manager, and were confident they would be listened to.

People could express their views and discuss any issues with the provider, registered manager or staff. The culture of the service was homely and family-orientated.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. The home could accommodate 30 people and, when we visited, there were 28 people living in the home with one person in hospital for a short stay and one vacancy.

We spoke briefly with all the people living in the home and we spoke with five at greater length. We looked in detail at five care plans. We also spoke with five relatives who were visiting the home during our inspection.

We spoke with the registered manager and nine other members of staff including the cook, the quality assurance supervisor, nursing and care staff.

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

Is the service safe?

We found that people's needs were assessed and their care and treatment was delivered in accordance with the care plan. There were assessments for risks such as manual handling, eating and the use of mobility aids.

Some of the people living in the home had complex needs and so the provider involved other healthcare specialists, such as, the dietician and tissue viability nurse, to ensure the provision of appropriate care and treatment.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

We found that staff had received appropriate training to meet the needs of the people living at the home. This included core training in areas such as manual handling, first aid and fire safety. In addition, there was additional training in areas such as dementia and end of life care. We found that there was a good understanding of the mental capacity act and best interest decision making.

Staff were keen to use the most effective practices to treat pressure sores and to prevent falls, for example. We also found care staff sought advice, where appropriate, from the qualified nurses. The nurses provided a high standard of nursing care and we observed an effective handover meeting. A relative we spoke with said, 'The care in this home is excellent. The nurses are very experienced and capable'.

We spoke with the quality assurance supervisor about the on-going work to record and monitor falls within the home. This work had involved the staff working with the local authority 'falls prevention team' and had been productive in identifying patterns and may result, over time, in a reduction in the number of falls.

Is the service caring?

One person we spoke with said, 'They look after me very well. I am comfortable and happy and I have everything I need.'

We saw that the staff were kind and sensitive and took time, so that people were able to do things at their own pace. We observed high levels of respect and people were treated with consideration and dignity. They were encouraged to make choices and to exercise autonomy and independence where possible. People's rooms were furnished with personal items and staff knocked and waited to be invited in.

One member of staff said, 'I love it here. There is a nice, warm and friendly atmosphere and we work well together.'

Is the service responsive?

People's needs were assessed before they moved into the home and detailed care plans and risk assessments were maintained and reviewed regularly. We saw that the staff monitored weight, nutrition and hydration and maintained body charts for any sores or skin damage. Staff were diligent in assessment and monitoring and responsive to people's needs.

Call bells were answered promptly and staff were responsive to any changes in the health and wellbeing of people living in the home. If there were any concerns, care staff were quick to escalate issues to the qualified nurses and they would refer on to specialist healthcare professionals as appropriate.

The cook was a fully engaged member of the team and was responsive to different requests for meals and to any issues, such as portion size, raised by people living in the home or their relatives. The people we spoke with and their relatives were positive about the service and the food. The menus were well balanced and the cook was happy to respond to special requests for meals and to cater for special diets as required.

The activities coordinator was not present during our inspection, but people had access to a wide variety of activities within the home and, those who were able could take trips out.

Is the service well-led?

The home was well managed with a qualified team of professional care and nursing staff.

The provider collected feedback from the people living in the home and their relatives through regular meetings and surveys. The manager and staff acted on that feedback to improve the service.

The provider was using a structured framework to maintain high standards in the hone, for managing end of life care and for working with other healthcare partners.

Feedback from the relatives we spoke with was extremely positive and the people living in the home were happy with the care they received.

We spoke with the home manager, the deputy manager and five staff members. They all told us that they enjoyed working at Pinewood and felt valued as team members. One staff member said, "It really is a home from home here. I like coming to work". Another told us, "I've worked in places where there isn't the time to provide good care. It's very different here".