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 wh

We carried out an unannounced comprehensive inspection of this service on 17 and 23 December 2015. Some breaches of legal requirements were found. After the inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to safe care and treatment, consent and person-centred care.

We undertook this focussed inspection to check that they had followed their plan and to confirm that they now met the legal requirements in relation to the breaches found. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Pines Nursing Home on our website at www.cqc.org.uk.

The service had a manager in post who had completed the application to become the 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.

The Pines Nursing Home is a care home with nursing, providing nursing care and support for up to 50 people. It is located in Putney, in the London Borough of Wandsworth. There were 30 people using the service at the time of our inspection.

At our previous inspection we found that risk assessments and care plans were not always updated when people’s needs changed and we found that consent to care and treatment was not always clearly documented.

At this inspection, we found that improvements had been made in all of these areas.

Appropriate checks were in place which helped to identify risks to people and care records showed that risks to people were regularly assessed and managed appropriately.

Specific risk assessments were in place and they were reviewed on a monthly basis. Any high risk areas identified had relevant assessments, care plans, a plan of care to guide staff and other monitoring records which helped to manage the risks to people.

We did see some examples where staff had incorrectly scored some of the risk assessments tools. Although there was minimal impact as the management of the risk was not affected by this.

Mental capacity assessment forms were in place and they were specific to particular areas such as maintaining a safe environment, personal hygiene, manual handling and health promotion. Where people did not have the capacity to consent, best interests care plans were available and best interests meetings had taken place which helped to ensure their rights were respected.

Records were in place documenting the level of involvement of family members and how often they wished to be involved in care plan reviews and how often they wished to be kept up to date.

Individual preferences questionnaires were completed for people asking them for their preferences in relation to how they liked to be supported, this allowed for a more person centred level of care to take place.

Care records were arranged logically and each identified risk had relevant risk assessments, care plans and plan of care in place. Records were updated monthly.

We visited the home to check that the heating system had been repaired following our previous inspection in November 2013.

We checked ten bedrooms and communal areas around the home. We saw there were thermometers in each room and regular temperature checks were carried out and recorded. The average temperature in the bedrooms was 23 degrees.

People we spoke with all felt their rooms were warm enough. One person said that their room was too warm and asked for a portable fan to help cool the room down.

An anonymous safeguarding alert was received by the Care Quality Commission late on the 26 November 2013, stating that there was no heating or hot water at the home and that the electricity power kept failing.

An unannounced responsive inspection took place on the morning of the 27th November 2013.

We found that the majority of the home was warm but that some of the areas, bedrooms and bathrooms were cold or just warm. We found the hot water that we tested by touch to be hot.

We were told that during the weekend of the 23 – 24 November 2013 the heating had partially broken down. Additional portable heaters were put in bedrooms and extra blankets and duvets supplied to people who used the service. The lounge area had an open fire that was lit.

The electricity power also failed because of the additional portable heaters being turned on. We were told by staff and residents that the power was off for only a few minutes.

During our inspection we spoke with residents who told us, “It has been cold but I’ve got an extra blanket and a fire (portable heater)” and “I went to the sitting room when it was cold”.

Before we left the home we saw an email dated 27 November stating that work on the heating would start on the week of the 2 December 2013 if not before. We asked the manager to tell us when the engineers start on the repairs and when the problems have been resolved.

During our visit we spoke with people using the service, relatives and staff. The relatives we spoke with felt that the staff were supportive and were very nice. One person said that their relative "Had received a huge amount of support and encouragement from the staff".

We saw that staff treated the people using the service with dignity and respect. The staff we spoke with felt there were enough staff to provide care but more people would give them extra time to spend with people using the service. They also felt they had received enough training to enable them to do their job. One member of staff said that "The care given is good".

A person who used the service we spoke with said "I have received fabulous care".

We spoke with two people who use the service, one relative, one representative and four staff members during our visit.

The relative of the person who uses the service said that there was 'very good care' and the home 'could be top of the range'. The representative commented that 'the environment was very good' and 'I'm in regular contact with the manager who provides regular, clear updates on care'. A person using the service told us that the staff treated them with respect.

A member of staff said that she felt 'the home was not institutionalised' and 'had a nice atmosphere'.

On this occasion we did not speak to the people who use the service.

However, our findings tell us that people are provided with a good selection of quality food that is prepared to individual needs and tastes. The temperature of the home is monitored to ensure it is appropriate for the people who live there, and there are sufficient levels of staff to meet people’s needs.

We were unable to talk directly with people who use the service as at the time of our visit there was an outbreak of sickness infection at the service, and people were being nursed in their own rooms.

Staff conveyed a good understanding of peoples’ individual needs and of their preferences in relation to the support they require.

The atmosphere at the home was calm and relaxed.

This inspection took place on 17 and 23 December 2015 and was unannounced. The provider knew we would be returning for a second day. At our previous inspection on 30 May 2014 we found the provider was meeting the regulations we inspected.

The Pines Nursing Home is a care home with nursing, providing nursing care and support for up to 50 people. It is located in Putney, in the London Borough of Wandsworth. There were 39 people using the service at the time of our inspection.

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 using the service told us that they felt safe living at the home. They told us that staff treated them with respect and were kind. They told us they were very good at managing their personal care needs. However, the majority stated that staff did not always engage with them and did not always have time to sit down with them. We saw that staff had a caring attitude towards people but did not always engage with them, aside from when they were delivering personal care or supporting them at lunchtime.

People told us they enjoyed the food at the home and we saw that people were offered choices and a varied menu. The kitchen area was clean and well maintained. Good quality food, including fresh meat was purchased and meals looked appetising.

People did raise some concerns about the length of time it took for staff to respond to their call bells and some staff reported that they felt rushed. However, we found that staffing levels were determined according to dependency tools and stated levels at the home were consistent with accepted guidelines.

Care plans and risk assessments were not always updated when people’s needs changed and we found that consent to care and treatment was not always clearly documented.

The provider had robust staff recruitment checks in place and arranged comprehensive induction and ongoing training of staff. Staff had regular supervision but these discussions were not always recorded fully.

People had their healthcare needs met and a GP visited the service every week to see people that were unwell.

The registered manager held regular staff meetings and also carried out a number of audits to monitor the quality of service.

During this inspection we found breaches of Regulations relating to safe care, consent and care planning. You can see what action we told the provider to take at the back of the full version of the report.