Pine Lodge Care Home

On this page

• 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 assessed 3 quality statements from the effective key question, and we found areas of good practice. The scores for these areas have been combined, with scores based on the key question rating from the last inspection. Staff had increased their knowledge about the Mental Capacity Act 2005. People were now supported to make decisions and staff acted appropriately when people did not have capacity to make decisions. There had been improvements in the training staff received. People’s needs were now assessed following best practice guidance. People were supported to access health professionals and to live healthier lives.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives told us they had been involved in assessing their loved ones needs and care plans. One relative told us, "We went through (Name's) care plan again and looked at things like food. (Name) doesn’t always like sandwiches. Staff also discussed and what sort of music they like." Another relative told us, they had gone through their loved one's care plan with staff. A relative told us, they had discussed their spouses care plan and it was agreed to have their additional support extended for another year. They confirmed they were always involved in decisions. An example was when their loved one was storing food in their cheeks and staff asked if food could be pureed for them, the relative agreed this was a good idea.

The nominated individual told us that assessments are now completed before people move into the service, and that needs are being reviewed regularly. Staff told us that people’s care plans were reflective of their needs. If any changes or amendments were needed, we were told they can be updated instantly and in ‘real time’ using the service’s new electronic systems. We were told the care plans do give staff a great sense of what people need support with but they also have time to spend with people to get to know them. The nominated individual told us staff were now following the provider’s pre-admission assessment process. They described the process to us, which included meeting people and their relatives face to face and discussing their needs and wishes and arranging for people to visit the service if they wished. The management team used this information to assure themselves staff had the skills or information they required to meet people’s needs. They told us one person had moved in to the service since our last inspection. The nominated individual told us people had been involved in writing and reviewing their care plans.

There were effective systems in place to review people's needs and update care plans. The care plan we reviewed showed they had been regularly reviewed and updated when required. Staff had used recognised assessment tools such as the MUST score to identify when people are at risk of weight loss and the suggested action to take.

Relatives told us, people had a choice of food and drinks. Staff supported them to make choices and provide food and drink in the person's assessed way. A relative told us, "They come around with a menu and ask what they want." Another told us, "(Name) has gone up 2 dress sizes, they have a good appetite, and is given 3 or 4 choices for meals. They bought hot cross buns for the residents over Easter and made pancakes for pancake day. (Name) is also given a tipple of sherry which they enjoyed. The food is amazing." A relative told us, "Staff know (Name) is vegetarian, but they are unable to choose their meals." A relative confirmed, "Staff come around with the choices of meals. (Name) is able to access drinks, they have them regularly, they have a beaker with juice and the thickener in it."

The new electronic system asks the staff to be very detailed in the support they have given people. They are required to check the task they have completed but also write a small narrative to help other staff understand what has been completed. As this is a new system staff are still getting up to speed with the level of detailed needed but this is being closely monitored by the manager and the head of care. At our last inspection we found people were not always offered food which met their needs. Some action had been taken to address this however, people at risk of losing weight continued not to be offered food prepared in line with the local health trust ‘Food first for care homes’ guidance. The chef told us care staff had not informed them anyone required a high calorie, high protein diet to mitigate the risks of them losing weight. No high calorie meals or drinks were being prepared for people. The nominated individual told us they were not aware of this and confirmed some people continued to take food supplements to reduce their risk of losing weight. People continued to rely on food supplements rather than receiving food to meet their nutritional needs. People living with diabetes were now offered a diet low in sugar. The chef told us everyone was offered the same meal options but portions sizes or products used varied depending on people’s needs. For example, diabetics were offered reduced sugar alternatives to jam and sugar, such as fruits lower in sugar and brown bread. Food and fluid records were now accurate. Staff told us they recorded what people ate and drank when they at or drank it. Food records were no longer prepared in advance by night staff.

There were systems in place to make sure people received food and drink appropriate to their needs. However, people's dietary needs had not always been communicated to the kitchen staff. The chef did not always know people when people were at risk of losing weight and required a fortified diet. People had been referred to the dietician and were receiving supplements as prescribed but this was not being underpinned by their meals. Following the onsite assessment visit, the nominated individual confirmed the chef had been informed of who required a fortified diet and this was in place.

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.

Relatives told us, people had access to health professionals. One relative told us, "(Name) was having physio that wasn’t really working, as they couldn’t understand how to do the exercise. I wanted the physio involved so they could show staff how to do the exercises, so staff could then help (Name) to do them. This has helped (Name) to become more mobile."

Staff described how they worked with health professionals to monitor people's health and identify when there needs changed. The staff had referred people to the dietician and speech and language therapist when needed and followed their guidance.

Staff worked with health professionals when they visited the service. There were systems in place to make sure there was a senior staff member to go round with the GP and district nurse when they visited the service. Staff reported any concerns at handover and in the daily records so these could be raised quickly with the health professionals, to reduce the risk of people becoming unwell.

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.

Relatives told us people's choices were respected. A relative stated, "Staff listen to (Name) and respect their choices. I am always consulted before they make any changes for (Name). Sometimes (Name) will choose not to go to the dining room, and they are told it’s fine and they can have dinner in their room, this is only occasionally." Another relative has power of attorney over their parents health and welfare, staff involved them in decisions when needed. They told us, staff asked their relative what films they liked and did she prefer to sleep with the light on or off and favourite foods, which they were able to answer. We were told, staff encourage one person to join in communal activities but they choose not to, so they were not forced.

The nominated individual told us changing staff’s thinking around the MCA had been a challenge. However, they had supported staff to use the least rather than the most restrictive practice. People’s right to have others lawfully make decisions on their behalf was now being upheld. The management team told us some people had appointed people to make decisions on their behalf when they were no longer able. Staff demonstrated knowledge of their responsibilities under the Mental Capacity Act 2005. They were able to tell us what the terms capacity and best interest meant and how they applied to the support provided to people. We were told, “We always assume some one can make their own decisions unless there are concerns and they have been assessed. If they cannot we complete things we believe to be in their best interests. Such as, if someone is cared for in bed, but they decline personal care, if they cannot make this decision, we would provide this for them otherwise this can really affect their health. Whilst doing this we always explain what we are doing.” Another staff member told us, "We ask consent before doing anything with people. It starts in the morning with, would you like to get up or stay in bed for a little longer. Then what would you like for breakfast etc and goes on through the day. If someone refuses, we would try a different face of staff or come back a bit later.”

There were now systems in place to make sure the principles of the Mental Capacity Act 2005 were upheld. Action had been taken to review decisions people had made to ensure they remained what people wanted. At our last inspection we found 14 people shared a room with another person. Staff had worked with local authority to check if people were still happy to share a room. Two people had chosen to continue to share while other people had been supported to have a room of their own. A review had been completed of the service’s unrestricted social media page which contained photographs of people. The page was no longer open to the general public and photographs were only shared with people’s permission. The manager now controlled the page and what was uploaded to it. People's care plans contained information about their capacity and which decisions they were able to make. There was guidance about how to communicate the information and how people would respond for example non verbally. The service used CCTV in the communal areas, consent had been gained from people already living in the service but there was no system at present to inform people before they decided to move into the service. The nominated individual had added the consent to the admission process.