Pinehurst is a residential home in the seaside town of Dawlish. It is registered to provide accommodation and care for up to 20 people of all ages who may have mental health needs. This inspection took place on 24 and 26 May 2016 and was unannounced. At the time of the inspection, 17 people were living at the home. People were all physically independent and able to engage in conversation. People living at the service were all over 40 years old.The service had a registered manager. 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.
People expressed a high level of confidence in home. They told us they felt safe and happy living at Pinehurst. The atmosphere of the home was calm and relaxed throughout our inspection. There was laughter and appropriate banter between staff and people living at the service, as well as opportunities for quiet conversation.
People were supported by staff that knew them well. Staff were kind and caring and people spoke very highly of the care they received. One person said “The atmosphere is lovely, staff are nice, [name of registered manager] is great and you’re treated like you are one of the family”. There were enough staff available to meet people’s care needs safely. Staff worked in a calm, unhurried way and had time for talking and supporting people with activities of their choice. People were encouraged to maintain their independence and to be part of the local community.
Staff ensured people's privacy and dignity was respected at all times. They worked closely with people to ensure they understood their needs and preferences. People were involved in planning and reviewing their care and felt listened to by staff. Staff demonstrated a shared commitment to the wellbeing and care of the people they supported and respected people’s right to individuality and difference.
People were able to follow their interests and hobbies. There was also a range of activities available within the home which people enjoyed. Many people went out every day, either independently or supported by a member of staff. Staff had time to spend individually chatting with people. There were two holidays organised by the registered manager each year, where a group of people went away for a few days, supported by staff. These were greatly enjoyed.
Staff had received training in safeguarding adults and knew how to raise concerns if they were worried about anybody being harmed or neglected. They felt confident that if they had any concerns they could raise them with the registered manager and they would be acted upon quickly and effectively. One person said “If I was feeling nervous or unsafe I could go to anyone here, I feel perfectly safe”.
We observed medicines being administered and this was done safely and unhurriedly. Medicines were stored safely and all stock entering and leaving the home was accounted for. Staff received regular training in medicines management and medicines audits were completed to ensure consistent safe practice.
There were robust recruitment processes in place to ensure that suitable staff were employed. Staff were well supported by the registered manager through supervision and appraisal. High standards of care were encouraged through staff training and development. Staff participated in a wide range of training courses in topics relating to people’s care needs including medicines management, mental health, health and safety and safeguarding.
Staff had received training in, and understood the principles of the Mental Capacity Act 2005 (MCA) and the assumption that wherever possible people should make their own decisions about their care and treatment. We found that the registered manager had not fully understood how the MCA should be applied in a mental health setting. However, immediate actions were taken to remedy this, including seeking assistance from the community mental health team with a capacity assessment for one person and seeking MCA training provided by Devon County Council. We found there had been no detrimental effect on people living at the service.
We have made a recommendation about staff training on the subject of the Mental Capacity Act (2005).
Records showed each person had been assessed before they moved into the home and any potential risks to their health and welfare were identified. Where risks were identified there were measures in place to reduce these. We saw that staff were skilled at managing risks in relation to people’s mental health. We were told by health and social care professionals that the service was very good at recognising signs of people becoming unwell and supporting people safely at times of crisis. A social worker told us staff were “quick to recognise and act if mental state becomes risky”. The service’s ability to respond proactively to signs of people’s changing mental health meant that people achieved levels of mental stability that had not had in the past.
People were supported to eat and drink enough to ensure they maintained good health. We spoke with people about their meals and whether they enjoyed the food that was provided. Most people were positive. They said “Food is very nice and you just ask for an alternative if you don’t like it. They are very flexible”. However, some people said they would like more choice, particularly at teatime. We talked with the registered manager about this and they said that the menu choices were all generated by people themselves and people could always choose an alternative. However, they would encourage further discussion about this at the next house meeting and seek some new ideas.
People were supported to maintain good health from a number of visiting healthcare professionals. People told us they saw their GP or mental health worker when they needed to and we saw from records that there was close communication with health and social care professionals.
The culture of the home was person-centred, open and friendly. There was clear leadership from the registered manager. Quality monitoring systems were in place which were used to review and improve the service. There was ongoing investment in the home to ensure that the environment was well maintained and updated. The environment was safe, clean, homely and welcoming.
Not all notifications had been made to the Care Quality Commission in line with the provider’s legal responsibilities. This had not had any detrimental impact on people. We have made a recommendation about the registered manager keeping in touch with current CQC guidance.
People's needs were met by the adaptation, design and decoration of the service. There was an ongoing programme of maintenance at the home. It was decorated and furnished in a comfortable, homely way. The space was big enough for people to find some personal space when they needed it.