Pine Trees Care Centre is a care home which provides accommodation for up to 35 older people who require personal care. At the time of the inspection 33 people were using the service. Some of the people who lived at the service needed care and support due to dementia, sensory and /or physical disabilities. There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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 inspected Pine Trees Care Centre on 17,18,19 July 2017. The inspection was unannounced. We last completed a comprehensive inspection in February 2017 when it was rated as ‘requires improvement’. We found the service was not meeting the regulations in respect of how medicines were managed, or having satisfactory staffing levels. For both of these matters we issued warning notices. The registered persons were also not ensuring: the Care Quality Commission was notified of incidents required by law; there was an effective complaints procedure; there was a satisfactory quality assurance procedure, and recruitment checks completed on new staff were satisfactory.
In May 2017, we completed a focussed inspection to check if there had been improvements about medicines management. Although we concluded there had been some improvement, there were some outstanding issues which need to be resolved such ensuring all care plans had written protocols for ‘when required’ medicines, improving records about the administration of creams, improving the recording of refrigerator temperatures and improvement regarding staff training.
At the last comprehensive inspection we judged staffing arrangements were not satisfactory. For example staff were observed as being very busy, and there were delays in answering call bells. At this inspection we noted improvement in how staffing was organised. A deputy manager had also been appointed. There was a much calmer atmosphere at the service. However we still received some concerns, from staff and people who used the service, about staffing levels, and about the responsiveness of staff to call bells. We have recommended that staffing levels are kept under review.
We judged that people using the service were not safe. We received some positive comments from people, their relatives and staff. However, we had significant concerns about the care and treatment of some people, and how the registered persons had responded to one issue where an allegation of physical abuse had been made. Multi-disciplinary safeguarding investigations had concluded concerns about the practice of some staff; inappropriate and neglectful care practice received by some people, and concerns about the support received by some people with pressure care, mobility, and eating and drinking. Further investigations are ongoing, and the local authority had suspended further placements at the service. We were made aware of an incident, which occurred several months ago was not reported to CQC. Documentation about the fact finding investigation carried out by the registered manager was unsatisfactory, and when we requested a full report of the investigation, we received no response. The matter is currently considered by the local authority as a safeguarding issue, but at the time of writing the local authority officer also confirmed they had not received the requested report.
We were concerned about how risks were managed at the service. For example risk assessments were not being routinely reviewed, and we were concerned that suitable action was not being taken where there was evidence that people were at risk or subject to pressure sores, lack of hydration and good nutrition.
There was evidence that moving and handling equipment was not being used appropriately and this, for example, created a risk to people’s safety.
We were concerned about the service being well led. At the last comprehensive inspection we judged quality assurance and audit systems as not satisfactory. This inspection has resulted in a significant number of breaches in the regulations. Some of the breaches in the regulations which we highlighted at the inspection in February 2017 have not been complied with. Although we have not said there is an ongoing breach in the regulation about staffing levels, we have issued a recommendation that staffing levels are kept under review as there were still some concerns expressed about their adequacy. The registered persons have not taken suitable action to ensure suitable systems are in place to ensure standards, for example regarding care documentation, and care for the more vulnerable people at the service are looked after appropriately.
We had significant concerns about the maintenance and availability of satisfactory records within the service for example in respect of care records; staff supervision and induction and to demonstrate good governance.
We subsequently had significant concerns about the current management of the service and the ability of the registered persons to bring about improvement.
The environment was generally clean and well maintained. However we were concerned about how some potential infection control risks such as there not being enough anti-bacterial gel available.
Staff recruitment checks were adequate although the registered persons did not always obtain suitable staff references.
We had concerns about people not having suitable documentation when deprivation of liberty safeguard orders were needed to be put in place. These are required, under the Mental Capacity Act 2005, to protect people from risk, due to their lack of capacity to make decisions for themselves. The people we spoke with did not feel they had unnecessary restrictions in place for example people said they could move around the building as they wished, and get up and go to bed when they liked.
People were happy with food provided. For example we were told meals were “Lovely,” and “Excellent.” We observed people received suitable support at meal times. However records and procedures in place to assist people at risk of dehydration and malnutrition, and to support people with diabetes, were not satisfactory.
Overall, the provision and delivery of staff training was satisfactory, although some staff had not completed all training required by law. There were not satisfactory records of induction for some staff who had commenced employment since the last inspection. Staff said they had someone to one supervision meetings with a senior member of staff, but there were insufficient records in place to verify this occurred. Staff however told us they felt supported by senior staff and their colleagues.
Care records were not satisfactory, did not suitably detail people’s current needs, and were not regularly reviewed. The registered persons were in the process of setting up an electronic care planning system, but paper records were not being effectively maintained until this was implemented.
At the previous inspection we had concerns about the effectiveness of the service’s complaints procedure. At this inspection most people we spoke with, and their relatives, said they had confidence that complaints would be addressed. However one person who made a complaint told us although their complaint had been acknowledged, it had not been investigated. We found no record of this in the service’s complaints record.
People could see a GP or other medical professional such as a dentist as necessary. However records were not sufficient for us to check when people last saw some medical professionals.
The building was suitably adapted, for example for people with physical disabilities, well decorated and had clean and comfortable fixtures and fittings. There were no unpleasant odours.
People viewed staff positively. People said their privacy was maintained, and they were treated with respect and dignity. Comments received included: “They are lovely,” “Very kind,” and “Nice.” We also observed staff working in a kind, professional and caring manner. People looked well cared for, although some relatives and external professionals said some people’s personal care was not consistently maintained.
People had the opportunity to participate in a range of activities. These included quizzes, bingo, and arts and crafts. Some trips out were arranged. Events such as religious festivals and cultural celebrations such as St Piran’s Day were celebrated.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still 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 this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to 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 so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
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