About the service:

Pinehurst Care Centre is a care home providing accommodation and personal care for up to 50 older people. At the time of the inspection 40 people were in residence.

Pinehurst Care Centre is made up of two buildings. The main building has two units in this called Cedar unit and Hurst unit. The second building is the Pine unit.

People’s experience of using this service:

¿ Medicines procedures were not always handled safely.

¿ Records were not always up to date and accurate. We found missed signatures in medicines administration chart (MARs).

¿We found that risk assessments were updated following a fall or evidence of this in case notes.

¿ Mobility and falls risk assessments were not always reviewed and updated following an incident.

¿ Staff training was not up to date.

¿ Not all staff could demonstrate their understanding of how to meet the needs of people living with dementia.

¿ Recruitment process were in place to make sure, as far as possible, that people were protected from staff being employed who were not suitable.

¿ There was a choice and variety of meals and drinks offered to people, including alcohol.

¿ People were treated with care and kindness.

¿ People and relatives felt the service was safe.

¿ People and their relatives said staff were caring and respected their privacy and dignity.

¿ Staff felt the management was supportive and approachable. Staff were happy in their role which had a positive effect on people's wellbeing.

Rating at last inspection: Outstanding (Report published 28 September 2016)

Why we inspected: This was a planned unannounced inspection based on the rating at the last inspection

Enforcement:

We found a breach of regulation 17 relating to mitigating risks in the provider’s governance systems to ensure compliance with the fundamental standards.

Follow up:

¿ We will check that the action is taken.

¿ We will continue to monitor all information we receive about this service.

¿ We will carry out a comprehensive inspection within one year of the publication of this report in

line with our methodology for services rated as requires improvement.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 28 July and 1 August 2016 and was unannounced.

Pinehurst care Centre is a care home providing accommodation and personal care for up to 50 older people. At the time of the inspection 45 people were in residence. 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. The service benefitted from the stable management of the registered manager and the care manager who had both been in post for a number of years.

People were safe at Pinehurst Care Centre which provided a warm, open culture that was welcoming to everyone. They were protected by staff who had the knowledge and skills to identify and report any safeguarding issues. People were protected from being cared for by unsuitable staff as the provider completed thorough recruitment checks. We found there were sufficient numbers of staff to meet people’s needs. People received their medicines safely and when they required them.

Risk assessments were completed and included those associated with falls, skin integrity and nutrition as well as those related to the environment such as fire and legionella. When risks were identified guidance was provided to minimise the risk while still respecting people’s freedom and choice.

People had their right to make decisions protected. The registered manager understood their responsibilities with regard to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). When appropriate, applications had been made for DoLS authorisations and these were reviewed in accordance with the current legislation. Staff understood their responsibilities regarding gaining consent and offering choice to people. They helped people to be as independent as they wished to be.

People were cared for by staff who were supported through effective training, supervision and appraisal. People told us that staff went over and above their duties to ensure they were well looked after and their needs were met. Some of the descriptions of the service were “outstanding”, “excellent” and “my home”. Relatives told us they found the staff to be “loving and caring” and made comments such as “staff are brilliant” and “the care is excellent”. We observed people were treated with kindness and empathy and we were told about examples of how staff had gone over and above the call of duty to make a difference to people’s lives.

There was an atmosphere of relaxed happiness, with people and staff smiling, singing and dancing. Staff engaged and communicated with people in a way that demonstrated they knew each other well.

People were supported to discuss the care they wished to have at the end of their lives and the service worked closely with the GP, other health professionals and their family to ensure their wishes were met. A health care professional told us, in their view the managers had kept people’s wishes as their topmost priority.

The service was responsive to people’s needs and comments from people and their relatives supported this view. People’s needs were thoroughly assessed and their personal preferences formed the basis of their care plan.

The provider had introduced a number of innovative ideas to provide responsive care. These included a project called ‘people like me’ which promoted conversations and engagement between people and staff. We heard about a number of success stories that had led to people and staff realising they had shared experiences and common interests. The activity staff enthusiastically embraced the development of new ideas and spoke passionately about ‘Ladder to the Moon’ an initiative to provide creative approaches to person centred activities.

A full and varied programme of a

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with six people who use the service, three visitors, the registered manager, the head of care, two care staff and the cook. We reviewed records relating to the management of the home which included, six care plans, daily care records, risk assessments, audits, policies and staff duty rotas. We also spoke to the local authority Commissioners.

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.

Is the service safe?

People had been cared for in an environment that was safe and there were enough staff on duty to meet the needs of people living in the home. A member of the management team was available on call in case of emergencies.

Care plans gave guidance and instruction to staff on how to meet people's needs in a way which minimised risk for the individual. They ensured that staff had the information necessary to support people safely. Staff were well trained and well supported to enable them to provide safe care to the people who lived in the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We spoke with the manager with regard to the Supreme Court ruling which widened and clarified the definition of deprivation of liberty. They were aware of the ruling and had been in contact with the local authority deprivation of liberty safeguards (DoLSs) team. At the time of the inspection no-one in the home had a DoLS authorisation and the manager was awaiting further guidance from the local authority.

Is the service effective?

People all had an individual care plan which set out their care needs. People were referred when necessary to a range of health care professionals including GPs, tissue viability nurses and dieticians. Directions from professionals were recorded accurately in the care plan and staff we spoke with knew how to access and follow them.

We observed staff supporting people in a friendly, kind and patient manner. We saw choice being offered and explanations given. We saw staff engaged with people whenever they entered a room, people responded positively to this interaction by replying or smiling. One person we spoke with said: “if I can’t be in my own home, I want to be here and nowhere else.”

People were supported to eat and drink sufficient amounts to meet their needs. We observed the lunch time activity and spoke with people afterwards. They told us they thought the food was, “very good.” Relatives of people living at the home told us they felt the food was good and there was plenty of choice.

During the inspection we saw staff supporting people with activities. People were encouraged to join in and we saw people laughing, smiling, clapping and singing.

Is the service caring?

People said they were supported by kind and attentive staff. One person said: “staff are very good, they really care, care with capital CARE.” Our observations confirmed this and we saw people being spoken to politely and with respect. Staff showed patience and were encouraging when supporting people in everyday tasks and activities. One relative said they were very happy with the care their loved one received, and added they didn’t think they would still be alive if it wasn’t for the care they had received in the home.

Is the service responsive?

People’s needs had been assessed before they moved into the home. People’s needs were reviewed with them and their relatives as appropriate. Records confirmed people’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes. People had access to activities that were important to them and they had been supported to maintain relationships with their friends and relatives.

We spoke with six people and three relatives of people who use the service. They told us they could talk to staff if they were unhappy about something. They all said they felt confident they would be listened to. People told us they knew how to make a complaint if necessary. One told us: “the office door is always open; I can say if something isn’t right and it will be dealt with so there is no need for anything to go further.”

Is the service well-led?

Quality assurance processes were in place. Staff told us they felt they could approach the manager for advice. They knew and understood their responsibilities and the importance of their role. Regular staff meetings were held to ensure staff were up to date. Staff we spoke with confirmed they were able to discuss matters with the manager who held an “open door” policy.

People and their relatives said they were consulted about their views and they completed satisfaction questionnaires. Residents meetings were held and relatives were invited to attend these meetings.

We spoke with three people who use the service, the registered manager and the cleaner on duty during our inspection. We found there was an effective system in place designed to prevent the spread of infection. We saw evidence of cleaning schedules and auditing of cleaning arrangements to ensure appropriate standards of cleanliness and hygiene were maintained.

People we spoke with told us they found the home was kept very clean. The cleaner was able to explain to us the precautions they took to keep people’s rooms and shared and communal areas, including bathrooms and toilets, clean. One of the cleaners said “I only sign the cleaning log when I’ve completed everything.”

From the observations we made, we found the home was clean. Staff were aware of appropriate actions to take to ensure people were not at risk of harm due to cross contamination.

We spoke with seven people who use the service, and one person’s relative. One person told us “I feel very safe and happy here.” Another told us “staff really care. That’s very important.”

We observed care plans included consent agreements which had been signed by people who use the service or by relatives if they acted as the person’s advocate.

We saw care plans were person centred. They noted people’s abilities, needs and independence. We spoke with four care workers. They all explained how they understood people’s support needs by following care plans and getting to know people as individuals. One care worker said “it’s in the care assessment, and reflected in their care plans.”

We noted the home was clean. We saw there was an infection control policy and procedure that provided guidance for staff to ensure people were protected from the spread of contamination. However, there was no documented evidence that daily and weekly cleaning routines had been completed as directed by the cleaning schedules. The manager told us cleaning audits had not been completed for the previous two months, due to staff absence.

Staff told us they were supported to develop their care skills through training, and undertook mandatory training that was kept up to date. They were offered further training opportunities, and managers held regular supervision meetings with them to support their learning and development.

The people who use this service prefer to be referred to as residents. This preference is respected within this report.

Residents we spoke with told us they had helped to plan the care they received and felt they were involved in making decisions about their care. They felt the staff respected their privacy and dignity and that they helped them to remain as independent as possible.

Residents told us they felt safe living at the home. They told us that staff were available when they needed them and that the staff had the skills they needed when providing their care and treatment.

Residents told us they felt their views were actively sought by the home and that their opinions were listened to and taken into account by the management and staff.