The inspection took place on 15 May 2017, and the visit was unannounced.

Pine View Care Home is a care home that provides residential care for up to 15 people. The home specialises in caring for older people. At the time of our inspection there were 12 people in residence.

Pine View care home had 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.

Staff were subject to a recruitment procedure that ensured staff were qualified and suitable to work at the home, however some staff files did not have a reference from their last employer. They received induction and on-going training for their specific job role, and were able to explain how they kept people safe from abuse. Staff were aware of whistleblowing and what external assistance there was to follow up and report suspected abuse. There were sufficient staff available to meet people’s personal care needs and we saw staff worked well in meeting people's needs.

The compliance and care managers’ undertook quality monitoring in the home, which then informed the board of directors on the progress of the home. However this had not picked up the shortfalls in care plans, risk assessments or staff files.

People felt staff were kind and caring, and their privacy and dignity was respected in the delivery of care and their choice of lifestyle. Care plans and risk assessments were in place but these could have been improved. People were involved in the review of their care plan, and when appropriate were happy for their relatives to be involved. We observed staff offered people everyday choices and respected their decisions. Staff had access to people’s care plans and received regular updates about people’s care needs.

People were provided with a choice of meals that met their dietary needs. The catering staff were provided with up to date information about people’s dietary needs, and staff sought the opinions of people to tailor their individual meal choices. Medicines were ordered, stored and administered safely and staff were trained to provide the medicines people required. Care plans included the changes to peoples care and treatment, and people attended routine health checks.

Staff provided planned activities for people over all seven days of the week. Staff had a good understanding of people’s care needs. People were able to maintain contact with family and friends as visitors were welcome without undue restrictions. Staff sought medical advice and support from health care professionals.

Staff told us they had access to information about people’s care and support needs and what was important to people. Staff knew they could make comments or raise concerns with the management team about the way the service was run.

The provider had a clear management structure within the home, which meant that the staff were aware who to contact out of hours. The provider had developed opportunities for people to express their views about the service. These included the views and suggestions from people using the service, their relatives and health and social care professionals. We received positive feedback from visiting professionals with regard to the care offered to people and professionalism of nursing staff. Staff were aware of the reporting procedure for faults and repairs and had access to the maintenance to manage any emergency repairs.

This inspection took place on 20 November 2014 and was unannounced.

Pine View Care Home provides care and support for up to 15 people who require personal care. Some people using the service are older people, some have some degree of dementia and some have other types of mental health needs. At the time of our inspection there were 13 people using the service. The service is located in a residential area within Leicester city and accommodation is provided to people over two floors.

At our last inspection on 09 April 2014 we asked the provider to take action to make improvements. These were needed to ensure people were protected from the risk of infection, ensure the premises were adequately maintained to keep people safe, ensure medication was managed safely and so that systems were in place to monitor and assess the quality of care being delivered. We found that some of the required improvements had been made since our last inspection. However, we found that some further work was required in relation to the premises and the systems in place to monitor and assess the quality of the service.

There was a registered manager in post at the time of our inspection. 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 this service the registered manager was also the provider.

We found that the premises were not being adequately maintained and that the grounds of the home posed a risk to the safety of people using the service.

We found that the provider was not following current legislation in relation to people’s mental capacity. Although mental capacity assessments had been carried out where needed, no best interest meetings and decisions had been documented. People’s care plans did not document their consent or the agreement of their representative on an on-going basis.

There were systems in place to monitor the quality of the service being delivered. However, these were not being carried out effectively as the registered manager was unaware of the safety issues we identified with the premises.

We found that people were protected from the risk of infection at the service and that their medication was being managed safely. People felt safe and staff understood how and when to report any safeguarding concerns. Risks to people had been assessed and documented in their care plans and guidance was in place for staff to help them minimise those risks to people.

All of the people we spoke with were positive about the staff who cared for them. However, some people felt that staff lacked the time to spend with them and that there was little for them to do. People were encouraged to maintain their independence, however, we observed people who were less able were sitting for long periods of time with little or nothing to do.

Staff working at the home were positive about their role and the service. They had been appropriately recruited, trained and supported. Staff placed emphasis on people’s choice wherever possible. Many of the staff we spoke with felt that people’s care needs were met at the service but told us that they lacked quality time to spend with people. The provider used a dependency tool to measure staffing levels based on people’s care needs.

There was a management structure in place and staff were clear on their roles and responsibilities. Staff had received training to effectively deliver safe care to people. Staff told us that they felt supported and that they could approach the manager should they need to. However, staff supervisions and appraisals were not being held regularly at the service.

We found that Deprivation of Liberty Safeguards (DoLS) had been applied for appropriately at the service and that the registered manager had a good understanding of when these should be considered to protect people using the service from being unlawfully deprived of their liberty.

People were given sufficient food and drink to meet their needs and had a choice of what food they were given.

Staff treated people with compassion and respected their privacy and dignity. We saw that staff understood people’s individual needs. However, people were not involved in the planning of their care. There was a lack of activities for people at the service.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

We spoke with eight people that lived in the home, one visitor and three staff. Below is a summary of what we found. The summary is based on our observations during the inspection and what we learned when we spoke with people using the service. We also spoke with and observed the staff group and obtained information from the records we looked at. A person living in the home said, “I’ve been here a while now, I think it’s just like home, the food’s good and staff are nice.” Another person said, “We looked at many [care] homes and chose this one as it’s more like a home, and was not so clinical as some others.”

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

Is the service safe?

People told us they felt safe. The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit an application.

Care plans reflected people’s needs and staff understood how to support people in line with their care plans. They were written in an individual way ensuring people received personalised care from staff and staff were able to tell us how they met people’s individual’s needs. There were arrangements in place to deal with foreseeable emergencies such as individual evacuation plans in case of a serious event such as a fire. We noted that work was required to ensure care plans and other confidential material was held securely, as these were open to public view.

From our inspection of 19 September 2013 we found that there were some infection control issues. The provider had made some improvements.

Equipment in the home was well maintained and serviced regularly. We found medicines were managed, held and distributed to people safely, though the record system in use for controlled medicines could be made more secure. We also found out of date medication which was removed from the building whist our visit was on-going.

Is the service effective?

People’s health and care needs were assessed, and they and their representatives were involved in the agreement of their plans of care. We saw that people were treated with respect and dignity by staff. One person said to us, "We looked at many [care] homes and chose this one as it's more like a home, and was not so clinical as others." There were shortfalls with a number of the quality assurance processes.

Is the service caring?

The service worked well with other agencies and services to make sure people received care appropriate to their needs. We saw where people were supported by visiting doctors, specialists and district nurses on a regular basis.

Is the service responsive?

We noted that a fire escape ramp needed to be replaced, and this was rectified during the inspection. We found that the periodic monitoring of the fire and evacuation system was inadequate and required to be re-evaluated as this issue had not been picked up by the periodic monitoring process.

Is the service well-led?

Quality assurance systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. People using the service and their relatives, were invited to complete an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

We spoke with six people using the service and two relatives visiting their family members. We also spoke with a visiting healthcare professional and three members of staff.

We found that people were able to make informed decisions about their care and support. One person told us “the staff are absolutely first class. They always explain things to me and seek my permission.” One relative told us “you can’t ask for a better place than this. Everything is perfect; the staff and everything.”

We found people experienced care and support that met their needs and protected their rights. One person told us “the staff are nice and look after me. I have no complaints at all. The care here is very good.” Care and support was delivered in a way that met people’s needs and ensured their safety and welfare.

Whilst we found the provider had systems in place to reduce the risk and spread of infection, we found these systems were not always effective. There were a number of issues relating to the cleanliness of Pine View Care Home.

We found staff were supported in their work and were confident that they were able to provide the care people using the service required.

We found the provider had a complaints policy in place. People using the service, and their relatives, we spoke with told us they were aware of the provider’s complaints policy and how to make a complaint.

We spoke with five people who live at Pine View Care Home and asked them for their views about the home. People spoke positively about the home and told us they were able to make decisions about what time they got up and went to bed, and what time they ate. People’s comments included: - “I like it here they don’t expect me to join in if I don’t want to. The staff are okay and they talk to me as a person.” “I like it, it’ll do me. Everything I want. They don’t push you and the people are lovely.”

We observed people living at the home taking part in the day to day running of the home. One person was seen to be cleaning the window sills of the conservatory whilst another person cleaned the dining tables after the lunchtime meal before they vacuumed the dinning room.

We spoke with two members of care staff, who had a good understanding of the needs of the people they cared for. We observed their interactions with people and found care staff to respond to their needs and provide support and guidance reflective of people’s care plans. Records we looked at were up to date and had been regularly reviewed and showed people using the service were supported to access health care professionals.

People we spoke with told us they were happy at Pine View and that they liked the staff. People’s comments included: - “its heaven living here; it’s good to have company. I’ve travelled the world and now I’ve come to rest. I can’t fault the meals they’re very good. I’d recommend this place any day.”

Visitors who were visiting a relative at the service told us: - “We’re very pleased, the staff are lovely and the food is nice.” They told us they’d chosen the service as it was small and cosy. They went onto tell us that the service kept them informed about any developments concerning their relative.

People told us they have enough choice about how they spent their time and that they were treated with dignity and respect. Their comments included “definitely get enough privacy; I can go to my room when I want they don’t just barge into your room, they knock, or they shout can I come in”;“they are all very good” and “It’s quite a lovely home, all that staff are lovely and they talk to you nicely”.

People told us they were happy with the care provided. Peoples’ comments included “I couldn’t have come to a better place”; “we are looked after really well “and “it’s a lovely place I would recommend it to everybody, I’ve no complaints”. We saw that their care records did not always identify and reflect what their care needs actually were. People also said they would like more to do during the day. One person told us “sometimes it would be nice to do more but we can’t be busy all the time”.

People told us they felt safe living at the home. One said “the staff are all lovely here” and “they treat you very nicely, I would tell them if they didn’t but I don’t need to”. We found that staff were not all properly trained on how to keep people safe.

Three people told us they received the medication they needed but we found that they were not always receiving it at the times when it was needed.

People told us there were enough care workers to care for them. Their comments included “they are very good, they work hard but they are always available”; “I’m not sure how many there are, they are sometimes short but that’s due to sickness and you can’t help that” and “there’s always somebody around”.

People told us they were asked for their opinions but that this was mostly done informally. One said “it mostly crops up in conversation, usually over lunch time. You can speak to staff anytime though”. Another said “they don’t engage you much; they tend to get on with it”. Two people didn’t know whether there were any residents meetings.

This inspection took place on 15 December 2015 and was unannounced.

Pine View Care Home is a care home that provides residential care for up to 15 people. The home specialises in caring for older people. At the time of our inspection there were 12 people in residence.

A registered manager was in post. The registered manager is also the provider. 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 last inspection of the 20 November 2014 we asked the provider to take action. We asked them to make improvements in the assessing and monitoring the quality of service and improvements in the safety of the premises. We did not received an action plan from the provider to indicate the action they were going to take and be compliant. We found that the provider had taken the appropriate action in all three areas.

People were relaxed around the staff . Staff were able to explain how they kept people safe from abuse, and knew what external assistance there was to follow up and report suspected abuse. Staff were knowledgeable about their responsibilities and trained to look after people and protect them from harm and abuse.

Staff were recruited in accordance with the provider’s recruitment procedures that ensured staff were qualified and suitable to work at the home. We observed there to be sufficient staff available to meet people’s needs and worked in a co-ordinated manner.

Medicines were stored and administered safely, however some specialist medicine was not ordered in a timely manner which resulted in staff being unable to administer the medicine.

Staff received an appropriate induction and for their job role, however some staff have not received training and some lacked updated training.

Staff had access to people’s care records and were knowledgeable about people’s individual needs.

Staff communicated people’s dietary needs appropriately, which protected them from the risk of malnutrition. People’s care and support needs had been assessed and people were involved in the development of their plan of care.

People were provided with a choice of meals that met their dietary needs. Alternatives were provided for people that did not like the meal offered. There were drinks and snacks available throughout the day. Catering staff were provided with up to date information about people’s dietary needs.

We observed staff were kind and caring, and observed people’s privacy and dignity in the care they delivered. We observed staff speak to, and assist people in a kind, caring and compassionate way.

Staff had an understanding of people’s care needs, though some information within the care plan was missing.

People were involved in the review of their care plan, and when appropriate were happy for their relatives to be involved. We observed staff regularly offered people choices and responded promptly to people’s requests.

People told us that they were able to take part in their hobbies and interests when they chose to.

Staff told us they had access to information about people’s care and support needs and what was important to people. Care staff were supported and trained to ensure their knowledge, skills and practice in the delivery of care was updated, though some of the courses had not been updated recently. Staff knew they could make comments or raise concerns with the management team about the way the service was run and knew it would be acted on.

The provider had developed questionnaires for people to express their views about the service. These included the views and suggestions from people using the service, their relatives and health and social care professionals.

Staff sought appropriate medical advice and support from health care professionals. Care plans included the changes to peoples care and treatment. People felt confident to raise any issues, concerns or to make complaints to the staff.

We saw that the provider and staff interacted politely with people and they responded positively.

The provider had a clear management structure within the home, which meant that the staff were aware who to contact out of hours. Care staff understood their roles and responsibilities and knew how to obtain support. Staff had access to people’s care plans and received regular updates about people’s care needs.

There were effective systems in place for monitoring of the building and equipment which meant people lived in an environment which was regularly maintained. However the internal audits and monitoring of person centred planning did not reveal areas that were not fully detailed.

Staff were aware of the reporting process for repairing faults and breakages, and had access to contractors contact number for routine maintenance and emergency repairs.