We carried out an inspection of this service on 25 November 2015 at which two breaches of legal requirements were found. These breaches related to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, entitled Safe care and treatment, and Regulation 17 Good governance. After the inspection, the provider created an action plan detailing the steps they would take to meet the legal requirements in respect of these breaches.

We inspected the service on 29 March and 3 April 2017 and found that they had taken appropriate action and were no longer in breach of these regulations. At the last inspection, we had found wardrobes were not secured to the wall so risked toppling onto people, windows were not restricted to prevent falls from height, and fire doors did not have the required seals to work effectively. There was also insufficient storage for medicines. At this inspection we found that wardrobes were secured, windows restricted including the replacement of some older style doors, and new doors had been provided which were compliant with fire safety regulations.

A registered manager was in post. 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.

We checked the management of medicines and found that the treatment room had been refurbished and a new bench, additional cupboards, and a new medicine fridge had been provided. Safe procedures were in place for the ordering, receipt, storage and administration of medicines including controlled drugs.

There were suitable numbers of staff on duty during the inspection. Recruitment procedures were in place which helped to keep people safe from abuse including carrying out checks on the suitability of people to work with vulnerable adults.

Safeguarding policies and procedures were in place. There had been no recent safeguarding concerns, and staff had received appropriate training. They knew how to report any concerns of a safeguarding nature.

Safety checks on the premises and equipment had been carried out, including gas and electrical safety checks, and fire safety equipment. The premises were clean and staff followed the provider's infection control policy to help to prevent the spread of infection. Closed circuit television (CCTV) had been installed in communal areas, to help to keep people safe. Attention had been paid to CQC's policy regarding the use of surveillance in care homes.

Staff received regular training and supervision and felt well supported by the manager and deputy. Annual appraisals were also carried out. Specialist training to support people with specific health or care needs was also provided.

The service was operating within the principles of the Mental Capacity Act 2005 (MCA). Applications had been made to deprive people of their liberty in line with legal requirements and a log was maintained of Deprivation of Liberty Safeguards (DoLS) granted and due for renewal. Decisions made in people's best interests were appropriately recorded.

People were supported with eating and drinking and feedback about the quality of meals was positive. Special diets were catered for, and alternative choices were offered to people if they did not like any of the menu choices. Nutritional assessments were carried out, and action was taken if people were at risk of malnutrition.

The premises were clean and tidy, and people and relatives told us they liked the homely atmosphere. There had been some improvements made to the design and adaptation of the premises to help to support people living with dementia who need additional support with finding their way around the home, and may also experience visual or perceptual problems. Further work needed to be do

We carried out our inspection on 23 November 2015. The inspection was unannounced which meant that staff and registered provider did not know that we would be visiting.

The home was last inspected on 2 May 2014. We found they were meeting all the regulations we inspected.

The Pines Residential Care Home provides care and accommodation for up to 28 people, some of whom have a dementia related condition.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

The local authority had placed the home into ‘organisational safeguarding.’ This meant that the local authority was monitoring the whole home following concerns with certain aspects of medicines management and other practices. A local authority safeguarding officer told us that staff were working with them to address the issues raised.

We found some concerns with the condition of the premises. We noticed that some of the first floor windows had not been fitted with window restrictors. In addition, wardrobes had not been secured to the wall to prevent any accidents or incident. A risk assessment had not been undertaken to assess these risks.

Fire safety checks were carried out. However, we noticed that some of the special strips which were fitted to fire doors or frames to provide a smoke/heat resistant seal were partly missing. We noticed that the lock to the outside kitchen door was not secure. We passed our concerns to the local authority’s fire safety team and contracts and commissioning team.

Infection control procedures were in place. A new sluice facility had been built. We noticed however, this room had not been fitted with racks for the hygienic storage and drying of continence equipment. In addition, this room was unlocked. There was an odour of stale urine in one of the rooms we checked and this smell permeated along the first floor corridor. Following our inspection, the manager told us that this odour had been addressed.

We checked the storage of medicines and found that medicines awaiting disposal were stored on the floor or on top of a filing cabinet because there were not enough cupboards to store medicines safely. We found that other aspects of medicines management such as administration were carried out safely.

Safeguarding policies and procedures were in place. People and relatives told us that people felt safe at the home. Staff told us that they had not witnessed anything which had concerned them and were knowledgeable about what action they would take if abuse were suspected.

Safe recruitment procedures were followed and there were sufficient staff on duty at the time of the inspection. Staff received appropriate training and support to enable them to care for people effectively.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’ it also ensures unlawful restrictions are not placed on people in care homes and hospitals. The registered manager had submitted DoLS applications to the local authority for authorisation in line with legal requirements. Records showed that consent was sought from people and that their capacity to consent is considered and the Mental Capacity Act (2005) (MCA) was applied appropriately.

People were provided with support to meet their nutrition and hydration needs. The cook was knowledgeable about people’s dietary requirements. We saw that assistance was provided on a one to one basis and peo

We considered our inspection findings in order to answer the questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

Below is a summary of what we found:

Is the service safe?

We spoke with four relatives and six people to find out their opinions of The Pines. We also spoke with a clinician in challenging behaviour, a local authority reviewing officer, safeguarding officer, contracts and commissioning officer, a representative from a local activities charity and district nurse to find out their views. All spoke positively about the home.

People were treated with respect and dignity by the staff. The local authority’s safeguarding adults’ officer and contracts and commissioning officer did not raise any concerns about the service.

Systems were in place to make sure that lessons were learnt from events such as accidents and incidents and complaints and concerns. This reduced the risk to people and helped the service continually improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Although no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

Is the service effective?

People were extremely happy with the care that was delivered. They told us that their needs were met. One relative commented, “The care is second to none.”

It was clear from our observations, and through speaking with staff that they had a good understanding of people's care and support needs.

Is the service caring?

We saw that care workers showed patience and gave encouragement when supporting people. One person informed us, “The staff are lovely.”

Health and social care professionals informed us that they had no concerns about people’s care and welfare. The reviewing officer and member of the district nursing team with whom we spoke informed us that they were happy with the care that was delivered. There was a cheerful atmosphere; many staff had worked there for a considerable period of time. This experience contributed to the efficiency and skill with which staff carried out their duties.

Is the service responsive?

People's needs had been assessed before they visited the service. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives. A holiday had been organised for June 2014, to a local caravan park.

All professionals with whom we spoke were complimentary about the service. They informed us that staff contacted them immediately if there were any concerns. The reviewing officer told us, “They’re really good at listening to any advice and always are willing to take any actions to improve.”

We saw that referrals were made to the GP, district nursing team, challenging behaviour team, podiatrist, dentist and other health and social care workers. We noted that the advice of these health and social care professionals was incorporated into people's care plans which helped ensure staff were aware of this information.

Is the service well-led?

The service had a quality assurance system and records seen by us showed that identified shortfalls were addressed promptly.

The home had a complaints policy and people and relatives told us that they felt able to raise any concerns they had. The manager explained that no formal complaints had been made since 2010.

Staff told us they were clear about their roles and responsibilities. They informed us that regular meetings were held. This was confirmed by minutes of meetings. Staff morale at the home was good and staff spoke positively about working there and the support the manager gave them.

We found people's privacy and dignity were respected and people or their representatives were involved in decisions about care. One person using the service said, "The staff are good, I feel they respect me, I can do quite a lot for myself and they let me get on with it."

Many of the people who used the service had complex needs, which meant they were not able to tell us their experiences. We spoke with a visiting health professional who told us they had no concerns about the care provided to people at the home. We found that people's care needs were assessed and care was planned and delivered in the interests of people's safety and wellbeing.

We saw there was a choice of nutritious food and people were supported to eat and drink.

We saw there was enough equipment to promote the independence and comfort of people who used the service and the provider took steps to protect people from unsafe or unsuitable equipment.

We found there were effective recruitment and selection processes in place and appropriate checks were undertaken before staff began work. This ensured people were cared for by suitably qualified, skilled and experienced staff.

Many of the people at the home were not able to talk to us fully about their care due to their capacity to communicate.

However we were able to talk with a small group of people who said they were happy with their care.

For example one person said, "It's grand here, no complaints from me." Another person responded when we asked if they were happy "Oh yes, they are lovely here, I can do what I want, I don't like noise, but I don't have to do things if I don't want to."

The people living in the home who were spoken to told us that they were well looked after and enjoyed the food served to them. Two people said they were always offered a choice of food and could ask for other things if they did not like what was on the menu They said they could go to bed and get up when they wanted to and choose where and how to spend their time.

People said the home was warm and comfortable.

They said the staff were very caring and looked after them well. One person said 'there is always someone there when I need them'. They all felt that their needs were met and had no complaints about the care they received.