Pinehurst Rest 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.

Pinehurst Rest Home is registered to provide accommodation for up to 19 older people who require residential or nursing care. At the time of our inspection there were 17 people living at the home.

The inspection took place on 29 August 2018 and was unannounced.

As Pinehurst is a single location it has a registered provider who is also the manager of the home.. 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 manager is referred to as the registered provider throughout the report.

The last inspection of Pinehurst Rest Home was undertaken in April 2017 and the service was rated as ‘good’. Unfortunately, this rating had not been maintained.

There were not enough staff to safely and effectively care for people at the service which affected the quality of care they received. Staff were not able to spend time with people as they were focused on their tasks. Accidents and incidents were recorded and reported but there was no overview or analysis of the data by the registered provider. This meant that opportunities to identify patterns or trends were missed. Best interest decisions were not considered for people who lacked capacity which meant that the Mental Capacity Act (MCA) was not always being adhered to. The premises were not completely adapted to meet the needs of people living with dementia.

People were not always treated with kindness and dignity by staff, we had received a complaint prior to our inspection about this. The service was not always clean and smelled in some areas. People did not always have their concerns and complaints recorded and were not confident these would be addressed or responded to. Care plans were not always person centred or sufficiently detailed and activities for people required improvement. The registered provider had not implemented strategies for person-centred care or enabled continuous development or learning at the service. Quality assurance and audits had not been effective or robust in identifying issues or improving the service.

People and staff were engaged through meetings with management although people had not been enabled to complete questionnaires. People had enough to eat and drink, and received support from staff where a need had been identified. People's individual dietary requirements where met.

Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team or the police. Staff managed medicines in a safe way and were trained in the safe administration of medicines.

People would be protected in the event of an emergency. Each person had a plan which detailed the support they needed to get safely out of the building in an emergency. Appropriate safety checks were carried out on equipment and fire safety systems. Risks to people were managed safely. Staff routinely assessed individual risks to people in areas such as falls, skin integrity, pressure damage or behaviour. People were protected against the spread of infection within the service.

Staff induction and ongoing training was tailored to the needs of the people they supported. Staff received regular support in the form of annual appraisals and formal supervision to ensure they gave a good standard of safe care and support. Staff recruitment procedures were safe to ensure staff were suitable to support people in the service. End of life care was provided sensitively and in line with people's needs and preferences to ensure people had a pain free and dignified death.

People were supported to maintain good health as they had

Pinehurst Rest Home is a residential care home for up to 19 older people and for people who have dementia. People had a range of support needs including personal care and assistance with moving and handling. On the day of our inspection there were 17 people living at the home.

The provider was also the designated manager. The provider was responsible for the day to day

management of the home. They also have oversight of the management of the regulated activities and the main contact for the service with CQC. Providers 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 on 15 December 2015, we told the provider to take action on staff deployment, management of risks to people and good governance. We found improvements had been made and these actions have been completed. We also told the provider to ensure that processes were in place to ensure that people’s rights were protected if they lacked mental capacity. Some improvements had been made, however further work needed to be done to met the requirements.

People’s human rights were not always protected as the provider ensured that the requirements of the Mental Capacity Act 2005 were followed.

Where people were assessed to lack capacity to make some decisions, mental capacity assessments had been completed, but best interest decisions had not been recorded. Staff were heard to ask peoples consent before they provided care.

Where people’s liberty may be restricted to keep them safe, the provider had not always followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected. Some applications had been made to the local authority, however some had not.

The provider told us that they would take action to rectify this after the inspection. Improvements could be made in staff’s knowledge of the MCA.

There were sufficient staff to keep people safe. There were recruitment practises in place to ensure that staff were safe to work with people.

People were protected from avoidable harm. Staff received training in safeguarding adults and were able to demonstrate that they knew the procedures to follow should they have any concerns.

People’s medicines were administered, stored and disposed of safely. Staff were trained in the safe administration of medicines and kept relevant and accurate records. For people who had ‘as required’ medicine, there were guidelines in place to tell staff when and how to administer them.

Staff had written information about risks to people and how to manage these. Risk assessments were in place for a variety of tasks such as falls and moving and handling.

The provider ensured that actions had been taken after incidents and accidents occurred to reduce the likely hood of them happening again. However, they were not always informed of when incidents occurred. We have made a recommendation.

People had sufficient to eat and drink. People were offered a choice of what they would like to eat and drink. People’s weights were monitored on a regular basis to ensure that people remained healthy.

People were supported to maintain their health and well-being. People had regular access to health and social care professionals.

Staff were trained and had sufficient skills and knowledge to support people effectively. There was an induction programme in place which included staff undertaking the Care Certificate. Staff now received regular supervision and an annual appraisal.

People were well cared for and positive relationships had been established between people and staff. Staff interacted with people in a kind and caring manner.

Relatives and health professionals were involved in planning peoples care. People’s choices and views were respected by staff. Staff and the provider knew people’s choices and preferences. People’s privacy and dignity was respected.

People received a

This was an unannounced inspection that took place on 15 December 2015.

Pinehurst Rest Home is a residential care home for up to 19 older people, with a range of support needs including personal care and for some of who live with dementia. On the day of our inspection there were 16 people living at the home.

The provider was also the designated manager. The provider was responsible for the day to day management of the home. They are also have oversight of the management of the regulated activities and the main contact for the service with CQC. Providers 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 recruitment processes were not always robust. The provider had not always obtained references and Disclosure and Barring Service (DBS) checks before employees started work.

People were not always safe from harm as risk assessments for people were not always in place and some risk assessments had not been reviewed regularly. This included the use of bed rails for people.

People’s medicines were not always managed safely. For people that were prescribed PRN medication (this is medicine that can be taken as required, such as pain relief medicine) there were no guidelines in place to tell staff when and how to administer. However, people’s medicines were stored safely.

Mental capacity assessments had been completed, however the form the provider used to evidence the assessment was not robust as it did not follow the Mental Capacity Act Code of Practise guidance.

Staff had knowledge of safeguarding adult’s procedures and knew what to do if they suspected any type of abuse. Staff had received training regarding safeguarding and this was confirmed from the training records. People told us they felt safe in the home “Yes it’s safe here, I have nothing to feel unsafe about. I have a secure room, there are always people around and the call bell at a touch of a button they will come and help.”

There were sufficient staff deployed to meet people’s needs. The majority of people we spoke with told us that they thought there was enough staff to deal with their needs. One person told us “There is enough staff, very good. Everything done so well.”

People were supported to have enough to eat and drink. The chef and staff had a good knowledge of people’s likes and dislikes reading food and drink. Another person said “I am a fussy eater. I tell them if I don’t like something. If I don’t like the dinner they give me a choice I generally have an omelette.”

People were supported to access to healthcare services and maintain good health. There was evidence that people saw the GP, optician and community nurses. Health professionals told us that the home responded proactively and always contacted them if they were concerned about anyone.

People told us that they were happy living at the home. One person said “The staff treat me very well. They are happy and jolly and I can have a laugh with them. I haven’t had to do any washing for five years. My carer will do anything I ask.”

People’s privacy and dignity were respected. Staff knocked on doors before entering and referred to people by their preferred name. People appeared relaxed and content.

People told us staff always involved them in decisions on what care they were going to have. One person said “The staff always asks what you want to do. If you decide you want to have your dinner in your room that is okay. They always ask what help you want.” Staff knew peoples preferences, likes and dislikes well.

Care plans contained peoples personal history’s which provided staff with information as to what the person did prior to moving in and an initial assessment. People generally received personalised care and staff were responsive to peoples changing need. It was not always recorded in people’s care plans that they were involved in planning or reviewing their care or that t

This was a follow up review to check that the provider had completed the actions set at the last inspection on 14th February 2013.

We spoke with three people who used the service, five representatives of people who used the service, the manager and three members of staff. One person who used the service said “I am very lucky to be here, they look after me really well”. On representative said “I have a high regard for Pinehurst; they are 100% into putting people first”. The people who used the service and their representatives told us that they were involved in making decisions about their or their relatives’ care and treatment needs. They said that their or their relatives’ care needs were reviewed on a regular basis and that consent to care and treatment was usually verbally given on an ongoing basis.

People told us that they were treated with respect and dignity and that their privacy was always respected. We saw that a wide range of activities were arranged by Pinehurst that promoted peoples’ independence and involvement in the community.

Pinehurst staff were knowledgeable about the people that they looked after and were actively involved in monitoring any changes in their care needs. Representatives of people who used the service told us that their views and opinions on how the home was run were being continually sought. They told us that they felt relatives were being cared for in a safe and secure environment and by staff who treated their relatives well.

Our inspection took place between 11.00 and 16.30 hours and carried out on an 'unannounced' basis. This means that the service was not told beforehand that we would be visiting.

The majority of people who live at the service were involved in the review of the service through either their feedback or our observations of their interactions at service and with staff. We spoke with three carers (relatives) either on the day of our site visit or via telephone following our visit. We also consulted with five staff members. The site visit was facilitated by the registered manager/provider. On the day of our site visit there were eighteen people living at the service.

People who live at the service consistently told us that they liked living at Pinehurst Rest Home. This was because they felt safe and that it was a friendly place to live. Their comments about their experiences included: “I could not be better looked after by my own family” and “they make the time to care”. People told us about the flexibility in the daily routines and respect for their personal freedom and lifestyles. A person told us “I can go to bed and get up whenever I want I can even have a bath every day if I want”.

Carers spoke positively about their experience of the service and of the care their relative receives. A carer told us “I can visit anytime they immediately make you feel welcome”.

Some people do not use verbal forms of communication. Observation showed that some people used single words or gestures. Other people had their own style of communicating. For example, the use of body language, facial expressions or other forms of behaviour. We observed that staff recognised these none verbal communication and responded to them.

A carer told us of the prompt actions of the service in seeking medical advice and support for their relative. People and carers told us that they felt confident to raise any concerns they had with the provider and felt that this would be dealt with promptly.

People who live at the service described their meal as: “perfect” and “nice” . A person told us “It is a very traditional English menu which suites me, I have gained weight since moving here”. Several carers told us that they are invited to stay for meals if they wanted to.

People told us that staff know what to do to help them and of the kindness of staff, describing staff as: “lovely” “so caring” and “they can not do enough for you”. Several people told us that there is always staff around to help them when they wanted help. Carers spoke positively about the contact they have with staff describing staff as “wonderful people” and “they know mum so well”.