This inspection took place on 24 October 2018 and was unannounced.

The Pines Residential Care 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.

The Pines Residential Care Home accommodates 24 people in one adapted building. At the time of inspection there were 22 people living in the home. The home has three floors with the first two being used as living accommodation for people using the service. The third floor was for use by staff. Each bedroom has an en-suite with private toilet and basin.

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 home had a registered manager in post.

During our inspection, we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of Regulation 12 safe care and treatment, specifically surrounding medication management. We found that the storage and disposal of medications, homely medication, topical medication and recording was not managed safely.

The manager at the home undertook a series of audits and checks of the quality of the service provided to people. People and their relatives were consulted in a variety of ways. However we identified audits of medications had not identified the issues found. An external audit by a pharmacy had been carried out in 2017 and inspectors identified the same issues during the inspection.

The registered manager and staff understood the requirements of the Mental Capacity Act 2005 (MCA). This meant they were working within the law to support people who may lack capacity to make their own decisions. We saw that people were supported to make their own decisions and their choices were respected.

There was a safeguarding policy in place and staff were aware of the safeguarding procedure in relation to safeguarding adults and all were aware of the need to inform the manager immediately.

Care plans and risk assessments were person centred and they detailed people’s wishes and how they needed to be cared for. The care records we looked at contained good information about the support people required and recognised people's needs. All records we saw were complete, up to date and regularly reviewed.

We saw that the home’s environment and their rooms were nice, clean and well kept. There were ongoing improvements being made to the home’s communal areas. There was also a series of health and safety checks in place to ensure the building was safe.

An accessible complaints procedure had been developed and people had been provided with a copy of the complaints procedure for reference. People told us they knew how to complain in the event they needed to raise a concern.

Policies and procedures were in place and updated, such as safeguarding, complaints, medication and other health and safety topics. infection control standards were monitored and managed appropriately. There was an infection control policy in place to minimise the spread of infection, all staff were provided with appropriate personal protective equipment such as gloves and aprons.

The staff were friendly, welcoming and we observed good relationships were maintained with people living in the home with a kind and respectful approach to people’s care. The registered manager was a visible presence in and about the home and it was obvious that she knew the people who lived in the home well.

We found that robust recruitment practices were in place which included the completion of pre employment checks prior to a new member of staff working at the service. Staff receive

This inspection visit took place on 12 October 2016 and was unannounced.

The Pines Residential Care Home is a privately owned care home situated in a residential area of Bidston on the Wirral. The home is registered for 24 persons. At the time of the inspection visit there were 23 persons who lived at The Pines.

At the last inspection on 22 October 2013 the service was meeting the requirements of the regulations that were inspected at that time.

There was a registered manager in place. 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 looked at the recruitment of appointed staff members. We found appropriate checks had been undertaken before they had commenced their employment confirming they were safe to work with vulnerable people.

Staff spoken with and records seen confirmed an induction training and development programme was in place. Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people who lived at the home.

The registered manager had systems in place to record safeguarding concerns, accidents and incidents and take appropriate action when needed. Staff had received safeguarding training and they confirmed this when we spoke with them. They understood their responsibilities and process to go through should they witness any abusive practices.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.

We found sufficient staffing levels were in place to provide support people required. This was confirmed by our observations and people we spoke with. For example one person who lived at the home said, “They are really good, never rushed and always willing to spend time with you.”

We found medication procedures at the home were safe. Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required. Medicines were safely kept with appropriate arrangements for storing in place.

We found people had access to healthcare professionals and their healthcare needs were met.

People we spoke with were happy with the quality and quantities of meals provided. They also told us there were choices at meal times. During the day we saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration. Comments about the food included, “The food is very good. Lunch is a good experience as you can see.” Another person said, “I love the homemade cakes they bake.”

People told us they enjoyed activities and entertainers organised by the management team. An activity coordinator was employed and people who lived at the home were pleased with the games and events put on by them. One person who lived at the home said, “The staff are very good and try and keep people occupied. I do enjoy most of the games especially bingo.”

The registered manager had a complaints procedure which was made available to people on their admission to the home. People we spoke with told us they were happy and had no complaints.

We observed staff supporting people with their care during the inspection visit. We found staff to be patient, kind and caring. This was confirmed by people we spoke with.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included satisfaction surveys, audits, staff and resident meetings and care reviews.

We spoke to different people about this service to gain a balanced overview of what people experienced, what they thought and how they were cared for. We spoke to four people resident at the service, and to staff..

We asked people if they gave consent to the care they received and if they had been involved in planning their care and activities. They said that they and or their relatives had discussed and agreed to their plan of care. We saw that care plans were often signed by people. People said they “..get good care here” and that they could refuse care if they wanted to.

We asked people what they did if they wanted to complain or raise an issue. People said they talked to the staff or the manager who would listen and do something if they could. We saw leaflets about making a complaint in communal areas and we looked at records of complaints that had been made and the outcomes of investigations and actions taken.

We looked at the general cleanliness of the service and asked people if they thought the home was always clean. We asked staff how they disposed of clinical waste and what they told us met current guidelines. We observed staff washing their hands in a thorough way and staff told us they washed their hands before handling food and after caring for individual people. We observed the kitchen which was clean and had a separate hand-washing sink and laminated posters detailing steps to maintain food hygiene. Staff were able to tell us about the steps that they take to maintain food safety.

We asked people if there were enough staff available to care for them at all times and they said there were. We looked at records of staffing levels and asked staff how they maintained staffing levels to cover sickness, holidays or vacancies and they said that off duty staff always covered these shifts.

Staff told us that they had had training in dealing with complaints, infection control and food safety, and we saw records that confirmed this.

We observed staff caring for people in a friendly and pleasant way. Staff knew people’s individual needs and spoke to people respectfully and appropriately.

At the previous inspection 25 October 2012, we identified concerns regarding a lack of safeguarding vulnerable adults policies and training; a lack of support and training for staff and inadequate quality assurance processes. The provider sent us an action plan to tell us how the service would become compliant with the regulations.

The purpose of this inspection was to ascertain if these concerns had been addressed. At this inspection, we found the new manager had updated policies and procedures within the home. She had found areas for improvement and had begun to implement changes. We found the manager had introduced support and training for all staff. The staff had received safeguarding vulnerable adults training and safeguarding policies had been updated.

We spoke with two people who lived at the home. One person told us: "I have no complaints, they are wonderful." We found the manager had updated the complaints procedures and introduced residents’ meetings and questionnaires to gain people’s views about the quality of care they received.

We spoke with three people who told us that they were very happy living at the home. One person said the home was “first class” another said “I cannot fault the staff, they are always so helpful”. All the people we spoke with said they felt safe at the home. People told us their rooms were warm, comfortable and regularly cleaned. They told us the food was really good and that they were given plenty of choice in what they wanted to eat.

We found that staff had received very little training and support over the past twelve months. Although we could see that quality assurance monitoring systems had previously been in place, we found at this inspection that some systems had lapsed.

Some people wished to look after their own medicines and staff supported them to take their medicines safely. One person said “The staff order [my medicines] for me, but I do the rest; it’s good that they help me look after my own medicines."

Another person told us that the senior carers “Always give me my tablets when I need them." Other people spoken with said they were happy with how their medicines were given to them and that the staff were lovely and very kind.

During our visit we spoke with a person who had moved to live at The Pines a month ago. He told us that he had lived on his own for many years and always said he wouldn’t go into a care home, but it is absolutely first class. The food is better than the Adelphi Hotel. He likes to be called by his first name and to be able to call everyone by their first name, he does not want formality. The staff put him to sit with another person who has similar interests and life experience and they have become friends. He described how he and his family looked at a number of homes, but he knew immediately that this would be right for him.

One person we spoke with said: “I am so lucky to have this bedroom. I watch squirrels and rabbits in the garden and enjoy looking after my plants.”

One person we spoke with told us that the staff are ‘absolutely wonderful’, they are ‘cheery’ and love to have a joke. One member of staff in particular is a ‘bundle of fun’.

We looked at some satisfaction survey forms that had been completed recently by people living at the home. The comments that people had written included:

'Very satisfied, very homely, clean and friendly.'

'My family and friends are always made very welcome.'

'Staff are very caring, treated very well at all times.'

'Meals are very enjoyable, plenty of drinks and snacks.'

'I thoroughly enjoy my meals.'

'Sometimes I have to wait a long time for a member of staff to come into the room.'

'Lovely dinners, nice flavours and greatly presented.'

'The friendly, caring and homely atmosphere of the home is immediately apparent.'

'The maintenance and cleanliness are first class.'

'My chair and bed are very comfortable.'

'There is a warmth and understanding in the carers’ treatment of residents.'

'Senior management is accessible and sympathetic to problems.'

'I very much appreciate the surveillance provided by the management and staff and their willingness to act quickly eg calling the GP when necessary.'

One person wrote that they felt embarrassed because they couldn’t remember the names of individual members of staff. The manager told us that this was going to be addressed by having names embroidered onto the uniforms.

One person would like the evening meal to be later, but other were happy with current arrangements.

The survey forms also included comments made by relatives, and these were:

'All staff are very polite and caring.'

'Staff are always ready to listen which conveys to us that we can rest assured that [our relative’s] care is first class.'

'Staff are always welcoming when we arrive and readily bring us refreshments and make us feel at home.'

'I have found staff very approachable, generous and welcoming to me and to residents.'

One person raised some issues regarding a lack of outings and their relative gaining a considerable amount of weight, however they went on to write ‘I like Mum being at The Pines, she seems happy and speaks very highly of it and all of the staff. I also find the staff very friendly and eager to help.’

One person commented about clothing going missing in the laundry.