The Pines Residential Care Home

We found the following examples of good practice.

The home had recently experienced an outbreak of COVID-19 with some people and staff testing positive for COVID-19. Staff had followed national and local guidance during the outbreak to mitigate the risk of the spread of infection, working closely with the Wirral Infection Control Team.

Wirral Infection Control team visited the service on the 11 January 2022, with no concerns about infection control or COVID-19 management. At this visit, we found the same. There were robust policies and procedures in place and the manager, and the staff team had worked hard to mitigate the risk of COVID-19 within the home.

Excellent provisions were in place to ensure visitors were safe to see their loved ones. There were easy to read posters on the front entrance of the home politely advising visitors not to visit if they were experiencing any COVID-19 symptoms. Information on the symptoms to spot and other information about social distancing and visitation were clearly displayed.

All visits to the home were pre-booked via an online app that required visitors to answer screening questions regarding COVID-19. Visitors had their temperature checked by staff they visited, were required to show a negative lateral flow test and evidence that they were vaccinated against COVID-19. There was a dedicated visiting pod with its own separate entrance/exit so that visitors did not need to physically enter the home.

Staff wore appropriate personal protective equipment (PPE) to ensure people were protected as much as possible from the risk of cross infection. There was a sufficient PPE in stock. PPE and hand sanitising gel was located throughout the home.

Staff had received training in infection control and how to put on and take off PPE safely. Cleaning was being managed throughout the home in accordance with government guidelines and the home was clean and hygienic on the day we visited.

All staff and people living at the service took part in a regular programme of testing for COVID-19 and the manager had clear oversight of this process. All staff and residents were supported to access COVID-19 vaccinations. All staff were vaccinated in accordance with legal requirements.

There were regular checks in place to ensure that infection control standards were maintained.

The manager told us the provider was supportive and accessible for help and support if they needed it and had been in regular contact throughout the pandemic.

The Pines Residential Care Home is a residential care home. It provides personal and nursing care for up to 24 people. At the time of our inspection, 14 people lived in the home.

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

Feedback we received from staff, people and relatives was very positive. Improvements had been made in the areas we inspected and to the management of the home. As these changes were recent the provider was aware the improvements needed to be sustained however, they had made significant progress.

We observed care being delivered in the home and saw this was done in a caring and patient manner. We saw people were comfortable in the presence of staff and positive relationships had developed between people receiving support, relatives and care staff. Visitors told us staff were kind and treated their relatives with dignity and respect.

Improvements had been made to how environmental safety was monitored, and infection control standards were also monitored and managed appropriately.

Care plans and risk assessments were in place that now reflected the needs of the people. Medicines were managed safely and those staff who administered medication had had their competency to do so checked.

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. We saw consent was sought and recorded in line with the principles of the Mental Capacity Act 2005.

Improvements had been made to staff recruitment, induction, supervision and training processes. Staff attended meetings and had regular checks on their day to day practice. Staff we spoke with felt well supported.

Accidents and incidents were managed appropriately, and referrals were made to other professionals in a timely manner when needed. The registered manager had notified CQC of significant incidents when it was appropriate to do so. The provider and management team had a range of audits in place that helped drive improvements in the service. This helped to ensure people living in the home received the care they needed.

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 inadequate (published 15 October 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.

This service has been in special measures since 15 October 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall however, is still rated as inadequate in the responsive domain as this domain was not inspected during this inspection. Therefore, this service is still in special measures.

Why we inspected

A decision was made for us to inspect, examine and follow up what improvements had been made since we last visited the service. As a result, we undertook a focused inspection to review the domains of ‘safe’, ‘effective’ and’ well-led’ only. Our report is only based on the findings in those areas at this inspection. The ratings from the previous comprehensive inspection for the domains of ‘caring’ and ‘responsive’ were not looked at on this occasion.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

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

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.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The Pines Residential Home is a residential care home providing accommodation and personal care to up to 24 older people. At the time of the inspection, there were 20 people living in the home.

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

Although people told us they felt safe living in The Pines, we found that the environment was not always safely maintained and individual risks to people were not always accurately assessed. Not all concerns had been referred to the local safeguarding team as required. At the last inspection, the provider was in breach of regulation regarding the management of medicines and we found that they were still not managed safely. Safe recruitment practices were not all adhered to and there was not always enough staff on duty to meet people’s needs in a timely way.

People were not always supported to have maximum choice and control of their lives as not all required applications had been made to deprive people of their liberty. Although staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice as consent was not always sought and recorded in line with the principles of the Mental Capacity Act 2005. There were no formal systems in place to support staff in their role and not all staff had completed training necessary to ensure they could support people effectively. People told us they had enough to eat and drink, but there was very limited choice available.

The provider had not acted on risks they had previously been made aware of and this did not demonstrate a caring approach. Permanent staff knew the people they supported well. Staff interacted well with people and spoke with them kindly, but people’s dignity was not always maintained. People were not provided with any written information regarding the service to help them make decisions regarding their care and their feedback about the service they received, was not sought.

Care plans were not detailed enough, and did not always reflect people’s preferences, to enable support to be provided based on their needs and wishes. There was a lack of activities available and people told us there were no opportunities for them to be supported out in the local community, for trips or events. A policy was in place regarding complaints, but information on how to make a complaint was not advertised within the home. However, people told us they felt able to raise any concerns they had with staff or the manager. People told us their family members could visit at any time and would always be made welcome.

There was a manager in post, but they had not yet applied to become registered with CQC. Systems in place to monitor the quality and safety of the service were not effective and there was a lack of oversight by the provider, to ensure people received good care. CQC had not been notified of all reportable incidents or events that had occurred. Records regarding people’s care was not stored appropriately and several records requested during the inspection could not be located.

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 (Report published 11 December 2018) and there was a breach of Regulation 12 identified.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, not enough improvement had not been made and the provider was still in breach of regulation 12 and several other breaches were identified.

Why we inspected

The inspection was prompted in part due to concerns received about the quality and safety of the service being provided. A decision was made for us to inspect and examine those risks.

Enforcement

We have identified breaches in relation to the management of medicines, how people’s consent was sought and recorded, staffing levels, safe recruitment of staff, person centred care and the governance of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We will also meet with the provider to discuss the issues identified during the inspection and request an action plan to establish what actions they plan to take to improve the quality and safety of the service.

The Pines Residential Care 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.

The Pines Residential Care Home accommodates 24 people in one adapted building. At the time of inspection there were 22 people living in the home. The home has three floors with the first two being used as living accommodation for people using the service. The third floor was for use by staff. Each bedroom has an en-suite with private toilet and basin.

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. The home had a registered manager in post.

During our inspection, we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of Regulation 12 safe care and treatment, specifically surrounding medication management. We found that the storage and disposal of medications, homely medication, topical medication and recording was not managed safely.

The manager at the home undertook a series of audits and checks of the quality of the service provided to people. People and their relatives were consulted in a variety of ways. However we identified audits of medications had not identified the issues found. An external audit by a pharmacy had been carried out in 2017 and inspectors identified the same issues during the inspection.

The registered manager and staff understood the requirements of the Mental Capacity Act 2005 (MCA). This meant they were working within the law to support people who may lack capacity to make their own decisions. We saw that people were supported to make their own decisions and their choices were respected.

There was a safeguarding policy in place and staff were aware of the safeguarding procedure in relation to safeguarding adults and all were aware of the need to inform the manager immediately.

Care plans and risk assessments were person centred and they detailed people’s wishes and how they needed to be cared for. The care records we looked at contained good information about the support people required and recognised people's needs. All records we saw were complete, up to date and regularly reviewed.

We saw that the home’s environment and their rooms were nice, clean and well kept. There were ongoing improvements being made to the home’s communal areas. There was also a series of health and safety checks in place to ensure the building was safe.

An accessible complaints procedure had been developed and people had been provided with a copy of the complaints procedure for reference. People told us they knew how to complain in the event they needed to raise a concern.

Policies and procedures were in place and updated, such as safeguarding, complaints, medication and other health and safety topics. infection control standards were monitored and managed appropriately. There was an infection control policy in place to minimise the spread of infection, all staff were provided with appropriate personal protective equipment such as gloves and aprons.

The staff were friendly, welcoming and we observed good relationships were maintained with people living in the home with a kind and respectful approach to people’s care. The registered manager was a visible presence in and about the home and it was obvious that she knew the people who lived in the home well.

We found that robust recruitment practices were in place which included the completion of pre employment checks prior to a new member of staff working at the service. Staff received a comprehensive induction programme and had regular training and supervision to enable them to work safely and effectively.

The Pines Residential Care Home is a privately owned care home situated in a residential area of Bidston on the Wirral. The home is registered for 24 persons. At the time of the inspection visit there were 23 persons who lived at The Pines.

At the last inspection on 22 October 2013 the service was meeting the requirements of the regulations that were inspected at that time.

There was a registered manager in place. 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.

We looked at the recruitment of appointed staff members. We found appropriate checks had been undertaken before they had commenced their employment confirming they were safe to work with vulnerable people.

Staff spoken with and records seen confirmed an induction training and development programme was in place. Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people who lived at the home.

The registered manager had systems in place to record safeguarding concerns, accidents and incidents and take appropriate action when needed. Staff had received safeguarding training and they confirmed this when we spoke with them. They understood their responsibilities and process to go through should they witness any abusive practices.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.

We found sufficient staffing levels were in place to provide support people required. This was confirmed by our observations and people we spoke with. For example one person who lived at the home said, “They are really good, never rushed and always willing to spend time with you.”

We found medication procedures at the home were safe. Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required. Medicines were safely kept with appropriate arrangements for storing in place.

We found people had access to healthcare professionals and their healthcare needs were met.

People we spoke with were happy with the quality and quantities of meals provided. They also told us there were choices at meal times. During the day we saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration. Comments about the food included, “The food is very good. Lunch is a good experience as you can see.” Another person said, “I love the homemade cakes they bake.”

People told us they enjoyed activities and entertainers organised by the management team. An activity coordinator was employed and people who lived at the home were pleased with the games and events put on by them. One person who lived at the home said, “The staff are very good and try and keep people occupied. I do enjoy most of the games especially bingo.”

The registered manager had a complaints procedure which was made available to people on their admission to the home. People we spoke with told us they were happy and had no complaints.

We observed staff supporting people with their care during the inspection visit. We found staff to be patient, kind and caring. This was confirmed by people we spoke with.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included satisfaction surveys, audits, staff and resident meetings and care reviews.

We asked people if they gave consent to the care they received and if they had been involved in planning their care and activities. They said that they and or their relatives had discussed and agreed to their plan of care. We saw that care plans were often signed by people. People said they '..get good care here' and that they could refuse care if they wanted to.

We asked people what they did if they wanted to complain or raise an issue. People said they talked to the staff or the manager who would listen and do something if they could. We saw leaflets about making a complaint in communal areas and we looked at records of complaints that had been made and the outcomes of investigations and actions taken.

We looked at the general cleanliness of the service and asked people if they thought the home was always clean. We asked staff how they disposed of clinical waste and what they told us met current guidelines. We observed staff washing their hands in a thorough way and staff told us they washed their hands before handling food and after caring for individual people. We observed the kitchen which was clean and had a separate hand-washing sink and laminated posters detailing steps to maintain food hygiene. Staff were able to tell us about the steps that they take to maintain food safety.

We asked people if there were enough staff available to care for them at all times and they said there were. We looked at records of staffing levels and asked staff how they maintained staffing levels to cover sickness, holidays or vacancies and they said that off duty staff always covered these shifts.

Staff told us that they had had training in dealing with complaints, infection control and food safety, and we saw records that confirmed this.

We observed staff caring for people in a friendly and pleasant way. Staff knew people's individual needs and spoke to people respectfully and appropriately.

The purpose of this inspection was to ascertain if these concerns had been addressed. At this inspection, we found the new manager had updated policies and procedures within the home. She had found areas for improvement and had begun to implement changes. We found the manager had introduced support and training for all staff. The staff had received safeguarding vulnerable adults training and safeguarding policies had been updated.

We spoke with two people who lived at the home. One person told us: "I have no complaints, they are wonderful." We found the manager had updated the complaints procedures and introduced residents' meetings and questionnaires to gain people's views about the quality of care they received.

We found that staff had received very little training and support over the past twelve months. Although we could see that quality assurance monitoring systems had previously been in place, we found at this inspection that some systems had lapsed.