This inspection took place on 4 and 10 July 2017 and was unannounced. The first day of the inspection was unannounced, the provider knew we would be returning for a second day.
The Pines Nursing Home is a care home with nursing, providing support for up to 50 people. It is located in Putney, in the London Borough of Wandsworth. There were 34 people living in the home at the time of our inspection.
A comprehensive inspection was carried out on 17 and 23 December 2015 during which breaches of regulation were found in relation to safe care and treatment, consent and person centred care. We then carried out a focussed inspection on 15 November 2016 at which time the provider had met their action plan in response to the breaches found, however we did not improve the overall rating at this inspection as improvements needed to be sustained over a period of time.
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. 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 and their relatives were satisfied with the service. They said they felt safe in the presence of care workers. They told us that care workers respected their choices and allowed them freedom and that privacy and dignity was respected. They gave us examples where care workers had demonstrated these qualities. They also said the food at the home was good and we found that people received appropriate support in this regard.
Records showed that the provider had involved family members, friends and health professionals in best interest meetings for people who had been assessed as not having the mental capacity to make certain decisions about their care and support. Where it was felt that people were being deprived of their liberty, the provider complied with the Deprivation of Liberty Safeguards (DoLS).
People received their medicines in a timely manner and staff completed Medicine Administration Record (MAR) charts appropriately. Regular audits also took place which helped to ensure medicines practice was safe. However, we saw that some bottles and creams were being used past their recommended shelf life from when they had been opened. Some people had their medicines crushed before taking them, we found that although authorisation from the GP were held in people’s records, there was no evidence that the pharmacist had approved the crushing of medicines. This was highlighted to the registered manager who sought this authorisation immediately.
Standard risk assessments to monitor people at risk of malnutrition, falls and skin integrity were in place and reviewed regularly. If any areas indicated a high risk there was an associated care plan in place to manage the risk.
Each person was allocated a named nurse. The process of nursing care was clear and comprehensive and comprised of a thorough assessment, planning, implementation of care plan and monthly evaluation. Records showed involvement of people, their relatives and health care professionals. People’s healthcare needs were met by the provider. Care records included people’s medical histories and observations. Daily record charts documenting any visits from doctors, nurses, and any other professionals were maintained.
Care workers were familiar with safeguarding procedures and the steps they would take to protect people that were at risk of harm or abuse. They told us that they felt supported and praised the quality of the training they received. Records showed they received regular training and supervision.
We found that staff recruitment procedures were not always robust. Although staff files included completed application forms, references, proof of identity and address and criminal background checks, we saw some examples where gaps in employment history were not explored and some references were not verified. We have made a recommendation to the provider regarding the use of more robust recruitment procedures.
The provider had systems in place to monitor the quality of service. These included monthly reports from a regional manager, mealtime observations form the registered manager and audits such as infection control and medicines.