Pine Lodge Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We assessed 7 quality statements from the safe 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. There had been improvements in the management of risk and learning when things go wrong, incidents and accidents had been used to improve people’s support. Medicines were managed safely, and safeguarding concerns had been reported to the local authority. There were enough staff to meet people’s needs, who had been recruited safely. The environment people lived in had been improved. There were effective infection control processes in place.

This service scored 62 (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, staff had taken action when incidents had happened. They gave examples of how incidents had been managed and the changes made to reduce the risks of them happening again. A relative told us, "(Name) has had a few tumbles getting out of bed and out of the chair. They have a sensor mat by their bed. They’ve had to try and reinforce the message they need support getting around." Another relative commented, "(Name) had a couple of falls. The last fall they had was before Christmas and they fractured their pelvis, they are monitored a lot more closely and watched to see if they are trying to get up so they can be supported. Staff have helped them regain some of their mobility. They was told they wouldn’t walk again, but is now with support."

Staff recognised the signs of potential abuse and what they would do to report and keep people safe. Staff commented, “The new system we have in place helps us manage people better and be able to keep an eye on anything unsafe or that may be going wrong.” Other staff told us, “We as seniors keep an eye on the system and if things aren’t done or people have not been supported correctly, we can sort this very quickly.” The manager thought the system to raise safeguarding alerts had improved and notifications were being submitted appropriately.

There were systems in place to record incidents and accidents, these were analysed for patterns and trends. Action had been taken to reduce the risk of incidents happening again and reviewed to make sure the action had been effective. People's care plans had been updated and action taken had been to support the individual in a way that was appropriate for them.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People felt safe at the service. Relatives told us they felt their loved ones were safe at the service and they did not worry about them. A relative told us their loved one was “far safer here with 24 hour care”. Another relative said “it’s like leaving them with family”. People told us they trusted the staff and management team. One relative told us that the “new owners are so friendly” and “staff now are perfect”. Relatives told us they were confident to raise any concerns they had with the staff and any concerns had been addressed. A relative told us they, “could ask anyone and things are dealt with”. Another relative said there was “always someone there to help you”. A relative told us, " (Name) had a fall about 6-7 weeks ago. The home called for a paramedic, and they also notified the family. Family had a call from social services safeguarding to check care for (Name) was sufficient. They had got out of bed in the middle of the night and had a fall. The manager said (Name) has got all the help buttons in place, and they know about the buttons to ask for help."

Staff recognised the signs of potential abuse and what they would do to report and keep people safe. Staff commented, “The new system we have in place helps us manage people better and be able to keep an eye on anything unsafe or that may be going wrong.” Other staff told us, “We as seniors keep an eye on the system and if things aren’t done or people have not been supported correctly, we can sort this very quickly.” The manager told us, the system to raise safeguarding alerts had improved and notifications were being submitted appropriately.

Staff understood how to communicate with people in the way they preferred. We observed staff and people chatting and laughing together in a relaxed way, while people were waiting for their lunch to be served.

There were effective systems in place to report safeguarding concerns to the local authority. The manager kept a record of any concerns raised, action taken and the outcome of the alert. The manager worked with the local authority to establish the best outcome for people.

Staff had a good understanding of people's risks and how to safely support them. One relative told us that staff had, “faster reactions than their previous homes” and their loved one was “getting up more” following a stay in hospital. Another relative told us, "(Name) has the sides up on their bed. Another relative didn’t want this, but (Name) had tried to get out of bed and slipped down, it was (Name) who requested the padded side to be put up. (Name) loves walking with their frame. They hate people following, carers will walk a distance behind them, but still follow them." Another relative told us, "Staff are very good with (Name) they can no longer walk so has to be hoisted from bed to their wheelchair. (Name) had a pressure sore that was graded a grade 3 this was on a Saturday, but the following Tuesday the district nurse downgraded it to a 2. Since then, (Name) has been on the pressure flow mattress and has had no more bed sores since. This was about 7 months ago."

Staff told us, information regarding risks to people had dramatically improved. Staff described how they had received diabetes training and how this had improved the support people received. We were told, “This is so much better. The training and competency let us know that we are doing it correctly. We used to be so worried as we had little guidance, only using what I had learnt elsewhere, however now I feel we are all managing this really well.” Risk assessments had improved following the last inspection, to help the staff to understand the risks to people and what actions to take to minimise the risk occurring. “It’s so much easier to find out things about people with this, (the handheld device). We all have access to one and we write really important things about people that staff need to be aware like medicines or someone isn’t feeling well and needs monitoring.” Action had been taken to keep people safe in the event of an emergency. The nominated individual showed us personal emergency evacuations plans (PEEP) for each person. PEEPs are information about the assistance people require to escape to a place of safety and are used by staff and emergency professionals to evacuate people quickly and safely. PEEPs contained all the information needed for a safe evacuation including the support people needed and any additional risk such as the use of paraffin-based creams.

We observed staff supporting people to stand and move safely. The manager demonstrated how one person should stand encouraging them to push down on the arms of the chair and push up with their legs to assist them to stand. Together they counted 1, 2, 3 and the person stood safely. We also observed two carers assisting a person from an armchair to a wheelchair in a safe and caring manner. They told the person how they would help and what they were about to do. The person was relaxed during the move. We observed people no longer had alert mats in the bedroom to tell staff they were moving around unless there was an assessed need for these to keep them safe.

There were systems in place to review potential risks to people's health and welfare. There was clear guidance for staff to manage people's conditions, reduce the risks and take appropriate action when people became unwell. People's care plans were reviewed when incidents had happened or people's needs changed, this made sure staff had up to date information about how to support people. However, when people returned from hospital, their care plans had been updated but this had not included additional guidance. For example, a person had returned with a catheter. The catheter had been added to the care plan, but there was no guidance for staff about how to manage the potential risks. There were handover sessions between staff, when they changed shift, this enabled an exchange of information about any changes to people's support.

Relatives told us, they were happy with the building and the improvements which had been made. Comments included, "I have no concerns about the safety of the building, I am really happy with all the improvements that have been made." Also, "No concerns, they’ve been doing the place up. The decking was a bit unsafe a few years ago, but now changed to patio." Another relative told us, "No, they’ve done it up and it’s nice now, and doesn’t smell." A relative told us, "No, it’s all been done up and looking 100% better than it was, the improvements have been very good." One relative told us, their loved one was not safe to go out alone. They had tried to leave the building but had not managed this and was now more settled.

The nominated individual told us the provider had taken action to comply with all the actions required by Kent Fire & Rescue Service. They sent us a copy of a letter from Kent Fire & Rescue Service confirming this. The nominated individual told us since our last inspection they had contracted a company to maintain the building. They told us this meant they could arrange for professionals such as plumbers and electricians to respond promptly when needed. Staff told us that the recent improvements to the environment has had a positive impact on them. Staff said it was a much more “pleasant place to work and that it feels so clean, fresh and modern,” and “It’s very clear that (provider) is investing into the service. They are making lots of positive changes to the environment.”

During our inspection we observed work being completed to decorate the outside of the building and maintain a secure garden for people to use. Communal areas of the building had been redecorated and consideration had been given to recognised guidance around environments for people living with dementia. Carpets had been replaced with easy to clean vinyl and armchairs had been replaced and were also easy to clean.

There were systems in place to make sure issues with the building can be reported by staff and dealt with quickly. The manager completed regular walk rounds the building to check for any concerns or issues.

People told us there were enough staff to meet their needs. Residents told us, “The carers are very nice”, and “They treat us very well which is the most important thing”, and “They always have time to stop and talk to you.” A relative told us it was, “not just about the physical care” and on one particular visit “one of the girls was dancing with (Name) and it melted my heart” and that staff “are working really hard”. Another relative added, “staff support straight away”.

We found that there were enough staff on shift during the assessment visit. Staff told us although it was their day off, they wanted to be present during the site visit as they wanted to show how much work they have done to improve the service. Staff told us they felt more supported and were able to make suggestions and give feedback. They felt listened to and valued. The nominated individual told us they had taken action since our last inspection to make sure staff were recruited safely. They confirmed DBS checks had been completed and references obtained. They told us where they had been unable to obtain references they had placed notes on staff’s file to demonstrate why a reference was not recorded. The nominated individual told us they had arranged “Lots of face to face training for staff”. This was to support staff to ask questions and obtain any clarification they needed. Staff told us the training had improved and they had learnt from it. The nominated individual told us senior staff had completed refresher insulin administration training since our last inspection and all staff had completed diabetes training.

People were able to choose where they spent their time. Staff asked people if they would like to eat their meal in the dining room. They respected the person’s choice to remain in the lounge and arranged for them to eat comfortably in the armchair.

There were systems in place to recruit staff safely. There continued to be a minor shortfall in obtaining some references, this was legacy work from the previous management team and this had already been identified as an area of focus to improve. The management team calculated how many staff were required according to people's needs and this changed when people's needs changed. There were processes in place to make sure staff received training appropriate to their role and their competency checked.

Relatives told us they thought the service was kept clean and there was no odour. One relative said, "Yes, it smells fresh, one of the cleaners is always washing floors and is so thorough." Another relative told us, "Pine Lodge has just been completely redecorated, but there was no issue with smells and cleanliness even before hand. The area’s (Name) goes in are clean, the flooring and furniture has all been replaced and they have domestic staff on duty. It doesn’t smell dirty, but it doesn’t smell clinical either. It’s a homely smell. It’s quite clean." Other relatives told us the smell within the building had improved and confirmed more domestic staff had been employed.

Staff told us the management team had employed more domestic staff. This had improved the general cleanliness of the service. Staff told us, “We have plenty of personal protective equipment. All are locked away so they stay sterilised until people need them.” Staff told us they wore PPE when completing personal care with people.

The service was odour free and looked very clean throughout. We observed staff following good practice guidelines with the changing and disposal of gloves and aprons. Clinical waste bins were available for staff to dispose of soiled personal protective equipment. Staff were observed vacuuming under chairs and cleaning seat pads and side tables with disposable gloves on, to keep the communal areas clean.

There were processes in place to make sure the service was cleaned effectively. The management team completed daily walk rounds and audits to check the service was clean and identify any shortfalls. Improvements had been made to the environment such as washable flooring, to help staff maintain the required cleanliness.

People received their medicines as they preferred from staff who were kind and caring. People had their medicines needs assessed and reviewed on a regular basis. Where people could self-administer their medicines, they were supported to do this. Where people were prescribed medicines that needed to be administered before food and other medicines, staff told us this was usually not happening until after 8am. Although the medicines were not being given with other food or medicines, we were not assured people were not having their breakfast delayed and there was a risk these medicines could be given with food and other medicines. We spoke with the registered manager who assured us they would make sure people received these medicines earlier in the morning.

Staff said they felt supported and had received suitable training and competency assessments to administer and manage medicines safely. Staff felt confident using the new electronic recording (EMAR) system and had received training to use it.

There were processes in place to ensure people received their medicines safely however, staff were not always following these. There were some gaps in medicines administration records (MAR) charts where staff had not signed when they had administered the medicines. Staff were managing people’s insulin and blood glucose monitoring however, blood glucose levels were not being shared with or monitored by specialist healthcare professionals. This was discussed with the manager and followed up straight after the inspection. Some medicines were prescribed to given when required (PRN) to people to help with anxiety or pain relief. The PRN protocols were not always person centred and did not detail when staff should give a variable dose of the prescribed medicine. Regular audits were completed however, the issues we identified at the inspection had not been picked up by the audit process. However, staff were using the new EMAR system alongside the paper-based system to ensure people were getting their medicines correctly while the new EMAR system was set up.