About the service: Pinewood Rest Home provides accommodation and personal care for up to 16 older people, some of whom are living with dementia. There were 14 people living in the home at the time of this inspection.

People’s experience of using this service: The new manager had introduced an open, inclusive culture and ethos, which people, staff and external professionals spoke positively about.

At this inspection we found the new manager and the registered provider had made substantial improvements in the standard of care provided at the home. They were compliant with the fundamental standards set out by law although further actions were required to embed good working practices in the home.

Staff training was being reviewed and rescheduled where necessary, due to a lack of records of training completed. A supervision plan was in place and the manager was carrying out spot checks.

Ongoing improvements were being made regarding obtaining consent to care and support.

Improvements were continuing to be made to the premises / home environment.

Care plans were being reviewed and re-structured to improve personalisation, accuracy and accessibility.

The new management team were starting to improve and develop new systems for monitoring the safety and quality of service.

Improvements had been made in the way people’s medicines were managed and audits were carried out and recorded. There was a new facility for storing people’s medicines.

Staff understood the procedures for keeping people safe from harm or abuse.

People were supported to eat and drink well and the quality and choice of food had improved.

People were supported to maintain their mental and physical health and the service was working in partnership with external professionals.

Staff were friendly and caring and treated people with respect. There was a person centred team approach resulting in positive outcomes for people.

Staff demonstrated a good knowledge of people’s individual needs and preferences regarding their support. People were encouraged and supported to express their needs and wishes. Any concerns were listened to and followed up appropriately.

Rating at last inspection: Requires Improvement (report published 12 February 2018). This service has been rated Requires Improvement at the last two inspections.

Why we inspected: This was a planned inspection based on the rating of the service at the last inspection in November 2017.

Follow up: Going forward we will continue to monitor this service and plan to inspect in line with our re-inspection schedule for those services rated Requires Improvement. If any concerning information is received, we may inspection sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection visit took place on 22 and 23 November 2017 and was unannounced.

Pinewood Rest Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Pinewood Rest Home provides accommodation and personal care for up to 16 older people in one adapted building. The home does not provide nursing care. There were 12 people using the service at the time of this inspection, some of who were living with dementia.

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.

At the last inspection of this service in August 2015 we found that the systems in place to assess, monitor and improve the quality and safety of the service were not always operated effectively.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question Well Led to at least good.

At this inspection we found that some improvements had been made. The registered manager had implemented more comprehensive audits and the provider had made improvements to the home environment. However, the quality assurance systems were not robust and did not identify shortfalls in records and training. There was not a culture of continuous improvement and learning in the service. Service development planning needed to be introduced and for the registered manager to update her knowledge about the regulations and legislative framework.

Staff had not all received a comprehensive training programme, supervision and appraisal to support them to meet the needs of people living in the service.

The procedures and guidance for staff for the administration of ‘as required’ medicines were not safe so there was a risk of people not receiving their prescribed medicines, or receiving them inappropriately.

The procedures for obtaining consent to care and treatment did not reflect current legislation and guidance. There was a lack of understanding about who could consent to care being provided. Although the registered manager was aware of the need to apply for Deprivation of Liberty Safeguards (DoLS), this had not always been done appropriately.

People’s care records were not always up to date, relevant and accessible and did not evidence how people were involved in the process.

Quality assurance systems were still not robust and consistently applied in order to assess, monitor and improve the quality and safety of the service.

The system for ensuring all recruitment information was readily available to support the provider and registered manager to make safe recruitment decisions was not always effective.

There were sufficient staff deployed.

The majority of people we spoke with told us they always enjoyed the meals. People received appropriate support to eat and drink enough to meet their needs.

People were referred to other healthcare services when their health needs changed.

Staff respected people’s privacy and dignity and were responsive to their needs, choices and preferences.

People spoke positively about the service, staff and registered manager. There was a person centred culture at the home. Staff had positive caring relationships with people and supported them to make choices about their care.

People and relatives we spoke with told us they had no complaints and were comfortable to raise any concerns if they had them.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to ta

This was a follow-up inspection, to check the provider’s progress against areas where we found non-compliance on our previous inspection visit 23 April 2013. We inspected the service’s procedures and systems for cleanliness and infection control. We checked to see if the provider had addressed issues with the safety and suitability the premises. We spoke with a member of staff and the registered manager. It was not necessary for us to speak with people using the service during this follow-up inspection.

We found there were effective procedures and systems in place for cleanliness and infection control, and people were cared for in a clean and hygienic environment.

We also found the provider had addressed the issues we had identified previously regarding the safety and suitability of the premises. Essential maintenance had been carried out and the home had been redecorated.

We spoke with three people living at the service, two members of staff and the service’s manager. People told us they were happy at the service. One told us “it’s very homely” and another said they “couldn’t wish for anything better”.

The service took steps to ensure people were asked for their consent before they were given care or support. Where people lacked capacity to consent, the provider followed legal requirements to safeguard their rights. Care and support was planned and delivered in a way that was intended to ensure people's welfare. Care plans were detailed and person-centred, and supported staff to meet people’s different needs. Staff were observed to to be respectful and responsive to those different needs.

We found a number of significant issues concerning infection prevention and control, and have told the provider to make sure these issues are addressed quickly and in full.

We found the building was poorly maintained, which had resulted in premises that did not adequately support people’s health and well-being The provider had not taken the necessary steps required to protect people against the risks of unsafe or unsuitable premises.

The provider had in place effective recruitment and selection processes, and appropriate pre-employment checks were undertaken. This meant people were cared for by suitably qualified, skilled and experienced staff.

People were listened to and their comments and complaints were responded to appropriately.

We spoke with four people living in the home. They told us they were very happy at the home and felt they were well looked after. They knew the staff well and that staff would do anything for them. People said that they did not have any concerns or complaints but would raise these with the staff or the manager if they did.

Two people told us the food was pretty good and that they were always given a choice. They said that they were told the choices on the menu but if they wanted something else then they could request it. ‘Nothing was too much trouble for them which they appreciated’.

One person told us that they had recently come to the home for a couple of weeks as they couldn’t go back home. They felt that this was a nice place to be and wanted to stay.

Residents told us they had not received any up to date information about the home recently. A resident told us that they were aware of their care plan, they knew what was written and they agreed with it. Residents told us they had a drink and a biscuit before bed. They said they probably could ask for some food later but had never thought to. Residents told us they felt safe at the home. People told us that the home was kept clean. Residents told us they received their medication when they needed it. Residents told us the staff worked hard, that they would do anything for them and came when they called. We spoke with residents who did not recall being asked to complete a survey.

People we spoke to told us that they were not consulted about their care and they were not aware of their care plans. Residents we spoke to said they were able to make some choices during the day, for example, when they go to bed and when they get up in the morning.

Some people told us that the food was nice, while others said that it was not very good. The residents we spoke to said they could not get food in the evening after the teatime meal. They said if they did not eat their evening meal then they could not get anything else to eat until breakfast. The staff stated that night staff would get residents a snack if they asked. Residents also told us that they were no longer offered a choice for breakfast and were given the same breakfast each day. The residents were not unhappy with the breakfast they were given, saying that the staff knew what they liked for breakfast.

Residents told us that the cleaning staff had not been working over the Christmas period.

When we spoke with residents about how they felt the home was run generally, one resident told us that it was, ‘best not to say anything as no-one listens’.

This inspection visit took place on 10 and 11 August 2015 and was unannounced.

Pinewood Rest Home provides accommodation and personal care for up to 16 older people, some of whom are living with dementia. There were 13 people using the service at the time of this inspection.

The service has 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.

Quality assurance systems were in place but were inconsistently applied and the registered manager was not always enabled to be proactive. Actions identified as necessary to complete improvement plans were not always carried out by the provider.

Safe recruitment practices were followed and appropriate checks had been undertaken, which made sure only suitable staff were employed to care for people in the home. There were sufficient numbers of experienced staff to meet people’s needs.

Staff were supported to provide appropriate care to people because they received an induction and on-going training and supervision.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. Where people’s liberty or freedoms were at risk of being restricted, the proper authorisations were in place or had been applied for.

People received regular and on-going health checks and support to attend appointments. They were supported to eat and drink enough to meet their needs.

There was a very positive atmosphere within the home and people were very much at the heart of the service. People and their relatives were enabled to be involved in how care was delivered. Staff understood people’s individual needs and worked in a manner that respected people’s privacy and protected their dignity.

The service was responsive to people’s needs and staff listened to what they said. Staff were prompt to raise issues about people’s health and people were referred to health professionals when needed. People were confident they could raise concerns or complaints and that these would be dealt with.

People and their relatives spoke positively about how the service was managed. There was an open and transparent culture in the home. Staff felt they would be supported by the registered manager to raise any issues or concerns.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.