About the service: Pinelodge Care Home provides accommodation, nursing and personal care to older people. The care home accommodates up to 140 people in one purpose built building. At the time of the inspection 109 people were living there.

People’s experience of using this service:

The recruitment process was not robust. For example, full employment history had not always been taken and references not always verified to satisfy themselves that the person was fit to work in a care setting. People’s view on staffing varied, as did the staff team’s feedback. Staff hours were assessed in accordance with a dependency tool which calculated the number of hours of support people needed. There were systems in place to help ensure staff were trained and received regular supervision. Staff felt supported.

There were areas of the home that were in need of repair and refurbishment. There were plans to complete this work. However, bathrooms and communal toilets posed an infection control risk and did not make the bath or shower time experience pleasant.

People had their individual risks assessed and staff were aware of these. People were supported safely. People received their medicines when needed. People’s personal care needs were met and the internal monitoring showed a reduction of falls, weight loss and pressure ulcers. This indicated care was delivered in accordance with people’s assessed risks.

The provider had systems in place to help them identify and resolve any issues in the home. Many of the issues found on inspection had been identified through this process.

People were happy at the service and were supported by staff who knew them well. People felt privacy and dignity was promoted. People were able to choose how to spend their time and encouraged to make decisions about their care. People’s care plans included information that gave staff information on how to support people.

People told us they enjoyed the activities available. People had the opportunity to go out. Staff needed to be reminded to ensure everyone was given the opportunity to join in with activities each day and to communicate to people what was on offer. There were communal areas such as a tea room, pub and library. They were all used on the day of inspection, but staff told us they were typically used once a week.

The registered manager was well known throughout the home and people and staff were positive about them. All staff were clear about what was expected of them and the plans for the service were shared with them, along with any lessons learned from events or incidents.

The service met the characteristics for a rating of "Requires improvement" in two key questions and met the characteristics for a rating “Good” in three key questions.

More information about our inspection findings is in the full report. Please see the action we have told the provider to take’ section towards the end of the report

Rating at last inspection: At the last inspection the service was rated as requires improvement, with Well Led rated as inadequate. There were breaches of regulation. At this inspection we found that well led had improved it’s rating to requires improvement and the number of breaches had reduced.

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

We asked the provider for monthly updates on the progress of the refurbishment plan. We will continue to monitor the service to ensure it provides safe and effective care. We will plan further inspections in the future.

This inspection was carried out on 18 and 25 September 2018 and was unannounced. At their last inspection on 28 March 2017, they were found to be meeting the standards we inspected. At this inspection we found that there were some areas that required improvement and they were not meeting all the standards.

Pinelodge Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodates up to 140 people in an adapted building. At the time of the inspection there were 120 people living there.

The service had a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

There were systems in place to monitor the quality of the home. However, they had not identified the areas of concern that we found on inspection. However, people and staff were positive about the running of the home and the management team.

Most people were supported in a safe way. However, some assessments and processes did not always promote this. We also found that although there were systems in place to monitor medicines management, medicines were not consistently managed safely.

Staff knew how report any risks to people’s safety. However, fire safety needed to be reviewed to ensure staff knowledge was robust and infection control was not always promoted.

Feedback about staffing was mixed. Staff received regular updates to their training and were recruited safely.

Most people were supported in accordance with the principles of the Mental Capacity Act 2005. People gave mixed views about the food and the mealtime experience needed to be improved. The environment had some areas that needed to be addressed.

People told us most staff were kind, however some people told us other staff were not as kind. The service needed to ensure people’s dignity was always promoted and that people’s involvement needed to be consistently reflected in the planning of their care. Confidentiality was promoted with records held securely.

People did not receive care in a person-centred way and there were mixed views about the activities provided. There was a complaint’s process which people and their relatives knew how to use. However, not all issues or concerns were shared with the registered manager by staff.

You can see what action we told the provider to take at the back of the full version of the report.

This inspection was carried out on 28 March 2017 and was unannounced. At their last inspection on 13 October 2015, they were found to be meeting the standards we inspected. At this inspection we found that they had continued to meet the standards.

Pinelodge Care Home provides accommodation and nursing care for up to 140 older people, including people living with dementia. At the time of the inspection there were 136 people living there.

The service had a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

The registered manager was on annual leave at the time of this inspection however, the deputy manager demonstrated an in depth knowledge of the service, the people who used the service and the staff team. There were systems in place to monitor the quality of the service and these were being used effectively.

People told us they felt safe and individual risk assessments were in place. Staff were aware of how to promote safety and report any concerns. Accidents were reviewed to reduce the risk of a reoccurrence. People’s medicines were managed safely.

Staff were recruited safely, felt supported and completed regular training. There were mixed views about staffing levels. However, we observed that people had their needs met in a timely fashion.

People were encouraged to make choices and their consent was sought before care was provided. The staff worked in accordance with the principles of the MCA.

People were supported to eat and drink sufficient amounts and had regular, appropriate contact with health care professionals.

People were treated with dignity and respect. Staff had developed meaningful relationships with people and people told us they were kind. People were involved in planning their care and confidentiality was promoted.

People received care that met their needs and their care plans were clear and up to date. There were regular activities on offer which people enjoyed. People felt confident to raise concerns and told us that they would be addressed promptly.

When we inspected the service on 9 April 2015, we found there were a number of areas that impacted on people’s safety, welfare and health.

We placed the service into special measures and they had six months in which they were required to improve. At our unannounced inspection on 13 October 2015, we found that they had made the appropriate improvements and had systems in place to sustain the improvement.

Pinelodge Care Home provides accommodation and personal care for up to 140 older people, some of who live with dementia. There were 92 people living at the service on the day of our inspection. There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

CQC is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection applications had been made to the local authority and authorised in relation to people who lived at the service. Staff were clear of their role in relation to MCA and DoLS and this included assessing people’s capacity to promote people’s autonomy.

People received care that met their needs and care plans were developed with their involvement. Staff were aware of people’s needs and had formed positive relationships. Dignity, privacy and respect were promoted and staff were aware of what person centred care was.

There was a variety of food and people told us they enjoyed it. Appropriate support was offered to eat and drink. Healthcare was promoted and professionals were easily accessed. The service was visited by other professionals such as opticians, chiropodist and a hairdresser.

Activities were provided and people told us they had enough to do. Staff spent one to one time with people supporting them with hobbies, interests and going out. People’s feedback was sought through meetings and surveys. Actions were developed as a result of this feedback and any complaints received and these were completed promptly.

Staff received appropriate training and supervision. Leadership in the home had improved and staff were positive about this. There were systems in place to monitor the quality of the service and address any issues found. The service had involved external agencies to support them to maintain the improvement going forward.

This inspection was carried out on 9 April 2015 and was unannounced.

Pinelodge Care Home provides accommodation and personal care which include nursing care for up to 140 older people. 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 and associated Regulations about how the service is run.

When we last inspected the service on 30 September 2014 we found them to be meeting the required standards. At this inspection we found that they had not continued to meet the standards.

Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection applications had been made to the local authority in relation to people who lived at the service and were pending an outcome. Some staff were not fully aware of their role in relation to MCA and DoLS and how people were at risk of being deprived of their liberty.

People living at the home and their relatives told us they did not always get their needs met. This included personal care needs and health care needs. Personal care was task orientated as staff could not detail people’s needs and restriction on time due to staffing deployment and absence meant that it was sometimes task orientated.

Medicines were not always managed safely. Staff had not received up to date training or supervision of their practice to assess their competency. Records and stock of medicines were inaccurate.

The deputy manager told us that staff training was completed if they identified a staff member as needing it. As a result staff knowledge in some areas was limited and we observed poor practice, particularly in relation to moving and handling, pressure care and wound management where staff need for training had not been appropriately identified or delivered. Staff supervision meetings had recently started.

People’s nutritional and healthcare needs were not always met. Care plans required updating, as staff were not always aware of people’s specific needs and health conditions.

The management in the home had been working on improving systems to monitor, assess and improve the service. However, some areas for improvement had not been identified or resolved.

The dementia care unit had been improved. People were being engaged in activity and were supported when they became anxious.

At this inspection we found the service to be in breach of regulations 9, 10, 12, 13, 14, 17 and 18 of the Health and Social care Act 2008 (Regulated activities) Regulations 2014. CQC is considering the appropriate regulatory response to resolve the problems we found.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

Ensure that providers found to be providing inadequate care significantly improve

Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

When we inspected the service on 11 April 2014 we found that the systems in place for monitoring and assessing the quality of the service were limited and ineffective. At our inspection on 30 September 2014 we found that there were now new systems in place and these had been set out in accordance with the service’s specific requirements.

At our previous inspection of Pinelodge on 22 May 2014 we found that people were not protected from the risk of infection because appropriate guidance had not been followed. We judged this to have a moderate impact on the people who use the service and we issued the provider with a warning notice.

At our inspection on 30 September 2014 we toured the environment to review the cleanliness and infection control practices in the home. We spoke with the deputy manager, two domestic staff members, six care staff members, one visiting health professional and one relative of a person who used the service. All staff members that we spoke with confirmed to us that they had undertaken infection control training and were aware of the role in regards to the appropriate standards of cleanliness and infection control.

We saw that there had been significant improvements to the standard of cleanliness and infection control in the home. We viewed all areas of the building and found most areas to be clean, tidy and hygienic. Cleaning schedules and records were in place which demonstrated regular cleaning and monitoring of all areas of the home.

At our previous inspection on 11 April 2014 we found that the service was required to make improvements in regards to cleanliness and infection control. We issued the provider and manager with a warning notice which stated they were to be compliant by 12 May 2014.

However, at this inspection on 22 May 2014 we found the service had not made sufficient improvements in this area.

During this inspection we set out to answer our five key questions; is the service caring, responsive, safe, effective and well led?

Is the service safe?

Some areas in the home were dirty and unhygienic. We have told the service that this requires improvement as it posed a risk to people’s health and welfare.

Is the service effective?

The service had not completed their action plan and staff were not consistent in completing tasks set by the manager.

Is the service caring?

The manager and the senior staff were committed to the home and told us they wanted to achieve a good standard of cleanliness for people.

Is the service responsive?

The service had not responded appropriately to the warning notice issued for the standard of cleanliness and infection control at the last inspection.

Is the service well led?

We found there were shortcomings in the overall monitoring of the service and this required improvement.

At our previous inspection on 17 September 2013 we found that the service was required to make improvements in regards to cleanliness and infection control. They sent us an action plan which stated they would be compliant within two weeks of the inspection.

However, at this inspection on 11 April 2014 we found the service had not made sufficient improvements in this area.

During this inspection we set out to answer our five key questions; is the service caring, responsive, safe, effective and well led?

Is the service safe?

We saw that the service had plans in place for each individual in regards to an emergency. However, some of the staff we spoke with were not sure of people’s full names so this may have impacted on these plans.

The service had a safeguarding policy and procedure in place and staff had received training in relation to safeguarding people from the risk of abuse. However, the policy and training encouraged staff to not report outside of the service and to raise concerns internally. The manager told us that they would address this straight away. People who used the service told us that they felt safe and that staff were easy to talk to.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Relevant staff had been trained to understand when an application should be made, and how to submit one. The manager told us that there were three people with an authorised deprivation of liberty document in place. These were for various reasons and the manager was well aware of the reason for them.

Some areas in the home were dirty and unhygienic. We have told the service that this requires improvement as it may have posed a risk to people’s health and welfare.

Is the service effective?

Care plans were well written and clear. Care notes demonstrated that staff had a clear understanding of each person’s needs. People we spoke with told us that they received care and support in a way that they chose.

Is the service caring?

People we spoke with told us that the staff were kind and caring. One person told us, “It’s a fantastic place and the staff can’t do enough to make us happy and they look after us very well. The staff are very caring and gentle….they all seem to know what they are doing.”

We observed staff interaction and this was evident most of the time. We did note that on occasions during lunchtime staff did not listen clearly or wait for a response from a person before removing their dinner plate.

Is the service responsive?

The service had not responded appropriately to the compliance action for the standard of cleanliness and infection control at the last inspection. However, we saw when a person’s care needs changed, this was communicated through the staff team and the care plan was updated.

Is the service well led?

The manager was well supported by the deputy managers who were responsible for leading the team. The manager and the deputy managers were knowledgeable and were aware of the importance of leading your team well. The staff spoke highly of the manager and the deputy managers and told us that they felt it was a good service.

However, we found there were shortcomings in the overall monitoring of the service and this required improvement.

We previously visited Pinelodge in June 2012 and found that the provider was not compliant with a number of aspects of the relevant regulations. We required the provider to make improvements. The provider wrote to us setting out their action plan. We re-visited Pinelodge on 17 January 2013 to check whether improvements had been made and to address some further concerns that we had received.

We found that people or their relatives had been given information and had been consulted about the way that care and treatment was planned. People's independence was maintained and they were treated with dignity and respect. One person told us, "They always help you and they are always kind here. They will do anything for you."

We saw that people were cared for by staff that understood their needs. This was because their needs were assessed and care was planned according to those individual needs. One person said, “It’s very pleasant. Very pleased with the place. I like the atmosphere. I can’t say anything bad about the place."

People were safe at Pinelodge because the provider took steps to identify the potential for abuse and responded appropriately when abuse was alleged.

The provider had an effective system for monitoring the quality of the service and for responding to any shortfalls.

When we inspected this home on 08 August 2012 we spoke with some of the people living there. However, not everyone was able to express themselves verbally and so we used our Short Observational Framework for Inspection (SOFI) tool; a method that allows us to understand people’s experiences better. We also spoke with some relatives and visitors.

One person said, “It’s really nice here. There seems to be loads going on lately and they have a new lady who comes in to do games and painting and things”. Another person said, “There’s plenty to do, always something different. We had a singer come in yesterday.”

Relatives of people living at this home spoke highly of the level of interaction with the staff and praised the amount and variety of activities. One relative said, “There always seems to be someone on hand.”

We carried out our SOFI in the dementia unit for 36 minutes during a period just before lunch and saw three staff members chatting to nine people as they were getting ready to eat. We specifically lobserved three people during this period and saw that each person’s mood was largely positive and happy. We saw numerous exchanges between the staff and the three people we were monitoring that were humorous and light-hearted and often involved several people.

In a period just after lunch we saw that people in the dementia unit were enjoying petting a young kitten that had been brought in by one of the care staff. On another occasion we saw a nurse spontaneously engage with someone who was becoming anxious by kneeling by the person, holding hands, and speaking softly to the them; we could see that this had a calming effect.

Some of the people that live at Pinelodge have dementia and not everyone was able to tell us about what it was like to live there. To help us to understand the experiences they have we used our Short Observational Framework for Inspection (SOFI) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences. As well as using our SOFI tool we also carried out further observations and spoke with some people using the service as well as with relatives.

In the lunch period one person said, “They do everything they can for you; it’s alright here.” Another person complimented the chef who was offering people choices of cooked meals at lunchtime.

However, one visitor told us that they were frightened for the safety of their relative because of the increasingly aggressive behaviour of one of the other people living on the dementia unit and that the staff were not dealing with this effectively. They said of the staff “They wait for the blue touch paper to be lit before they act.”

In general, people using this service spoke well of the care staff although there were some differing views on the standard of care. One person said “I am treated very well, the carers are lovely, really nice. They make you feel special.”

Others said that they felt the staff were good and that they had no complaints. Relatives of people living in the home told us the staff team were very good, however they said there was a lack of activity provision at the home to provide people with stimulation and engagement.

One relative said “We are very happy with the care our relative receives” whilst another said “Put it this way, I would not choose for my relative to come in here when the time comes.”

During our inspection on 01 August and 05 August 2014 we set out to answer five questions. These were whether the service is caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

People who used the service told us that they felt safe and cared for. For example, one person told us, “We are well looked after. The nurses are good. The breakfast was nice. I am safe here and I have no concerns”. Another person said, “I am quite well. I had a stroke and I am having eating lessons from the speech therapist. I have no complaints. Definitely, I feel safe. The staff are friendly and very caring. The food is not too bad. So I am well cared for.”

We saw that there were posters displayed throughout the communal areas of the home informing people how to report any concerns or suspicions of abuse.

Is the service effective?

We spoke with a mental healthcare professional who visited the home daily to provide specialist help and support to people who lived with significant dementia care needs. They told us, “The dementia care needs of some people who live here are very high indeed. The staff manage their needs well.”

Is the service caring?

During our inspection we saw that staff treated people with respect and kindness while delivering appropriate levels of care and support.

Is the service responsive?

At a previous inspection of this service on 11 April 2014 we found that people were not protected from the risk of abuse because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. At our inspection on 01 and 05 August 2014 we found that the whistleblowing policy and procedure had been reviewed and that the guidance contained in the policy had been updated to support staff to disclose any concerns directly to appropriate authorities outside of the service.

Is the service well-led?

As part of our inspection we looked at care plans for eight people who used the service, six of whom had significant dementia care needs. We found that care plans provided information on how to support each person in meeting their needs. We saw that mental capacity assessments had been undertaken and that personal care had been delivered in accordance with the care plans and risk assessments.