Pinewood Residential Home

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We identified one breach of the legal regulations. The registered manager and provider did not demonstrate good understanding of the Mental Capacity Act 2005 and how to apply it to protect people’s right to be included in decisions about their care. Mental capacity assessments and best interests decisions had not always taken place where people had restrictions placed on them according to the law. The systems and processes in place did not always ensure people’s care records were up to date which increased the risks to people of receiving inconsistent support. People and their relatives told us staff responded promptly to people’s health needs. Staff knew people well and understood how to care for them in line with their preferences and choices. People’s records contained information from health professionals involved in their care and we observed staff supporting people safely.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

Whilst people were happy with the care they received, people had not always been actively involved in assessments or reviews of their needs and preferences. One person told us, “No one discussed my care when I came in. It disappointed me. I didn’t see [registered manager’s name] for 2 weeks. I didn’t know who was the senior and who was not.” We received mixed feedback from relatives about their involvement in their family member’s care. For example, one relative said, “Her care plan is reviewed, but her needs do not change much.” Whilst another relative told us, they had not been involved in the care plan process or the review of the care plan. Care records provided no assurance people and/or relatives had been included in care planning and reviews.

The registered manager acknowledged reviewing people’s care records had not been happening consistently. To address this and ensure people’s care records were reviewed and updated monthly, the registered manager had recently introduced a ‘resident of the day’ process which involved reviewing all aspects of care delivery in line with evidence-based practice. However, this had just been introduced and not yet been embedded into practice and therefore it was too early to assess if this approach was effective. Staff were able to describe people’s needs and how they cared for them in a safe way. For example, staff described how they monitored people’s nutrition and hydration, what actions they were taking to monitor people’s weight and how they were protecting people from skin damage.

Robust systems were not in place to monitor and ensure people's needs were consistently met. For example, monitoring charts had not been used effectively to ensure people regularly changed their position to reduce the risk of them developing skin damage in line with their care plan. The service used nationally recognised assessment tools to help them assess risk to people. However, assessments and care plans were not always up to date. For example, one person’s ‘waterlow’ skin assessment had not been reviewed and updated since April 2023 and their moving and handling risk assessment had not been reviewed since September 2022. Inconsistent information was viewed in people’s care records which related to managing people’s health and care needs. For example, one person’s nutritional guidance differed from what was recommended by the speech and language therapist (SALT).

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

People and their relatives told us staff were quick to respond to people’s health needs. Relatives told us staff contacted them if there were any concerns, sought timely medical advice for people and kept them informed of any appointments. One relative told us, “I have no concerns about how the staff deal with requests for the GP. The podiatrist visits regularly and the optician.” Another relative said, “They get the GP for him when needed, their communication is good when he is poorly

Staff knew people well and understood their health needs. Staff told us they had good relationships with health professionals involved with the service. The registered manager told us community nurses visited the service twice weekly and they were able to access people’s GP when needed.

The registered manager and staff supported people to live healthier lives. People’s records contained information from health professionals involved in their care and we observed staff supporting people safely. The service took part in a yearly hydration awareness week where they promoted and encouraged better management of hydration to keep people well. The service had a hydration and food station in the lounge area for people to access and staff looked at ways in which they could enhance people’s experience of food at the service. Staff also promoted people’s mental health with regular activities, including exercise activities and trips. A relative speaking about their family member told us, "He was so depressed before he came to Pinewood. They have turned his life around, they have given him back his incentive to live, he now says this is my home. Every day there is something to do, their ethos is so good. I visit every week and he is sitting in the lounge, and I hear him laughing.”

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

People told us staff always gave them choices and asked them what they wanted to do. One person said, “Everything they do they always ask, ‘can I do this, do that?’, always asking me before they do anything.” Relatives told us staff asked for people’s consent and involved them where appropriate. One relative said, “They always consult me, I hold Power of Attorney for finance and health.” Whilst people told us they experienced care in line with their wishes, we identified improvements were needed where people were unable to provide consent.

The registered manager told us where people were unable to make decisions about their care, people’s records contained mental capacity assessments and Deprivation of Liberty Safeguards (DoLS) applications had been made to the local authority where appropriate in line with the Mental Capacity Act 2005 (MCA). However, we found the registered manager’s application of the MCA showed a lack of knowledge and understanding of the principles of the MCA. Staff described the importance of obtaining people's consent and following the principles of the mental capacity act. One staff member told us, “With MCA, you should always assume they have capacity. We speak to people and if they cannot talk, we show them options. I always knock on their door and greet them and then I always ask for permission.” Some staff told us they had received MCA training but could not remember when they had last received this training as it was a long time ago.

Whilst we did not see unnecessary restrictions placed upon people, the service was not always working within the principles of the Mental Capacity Act (MCA) and the registered manager did not understand the processes that must be followed to ensure people were not being restricted unlawfully. Deprivation of Liberty Safeguards (DoLS) authorisations had been applied for where staff were placing restrictions on people. However, mental capacity assessments and best interests decisions had not taken place where people had restrictions placed on them according to the law. People who were considered by staff to not have capacity to make decisions, had general mental capacity assessments for care and consent only. There were no mental capacity assessments and best interests meetings recorded that were decision specific, such as, in relation to the use of bedrails and sensor alarm mats. There was no information that restrictions placed upon people was discussed with the person, their relatives and/or appropriate healthcare professionals, considering all possible options and the restriction was the least restrictive. The provider had not ensured that care and support provided by staff was in people's best interests. The failure to accurately assess and record people's capacity and best interests decisions risked compromising people's rights and was a breach of regulation. Since the assessment the registered manager had been working to ensure that all people with restrictions in place had been assessed and any decisions made had been made according to the Mental Capacity Act.