Pinewood Residential Home

We identified 2 breaches of the legal regulations.

People were not always protected from risks associated with their environment. We found hazardous chemicals were not stored safely, windows were not restricted in line with guidance, doors that should be secured were left open and people were not safe from the risk of fire.

Cleaning checks and records were in place. However, these had not always been completed and there was a lack of oversight in place to ensure the service was kept clean and free from infections. We made a recommendation about this.

Care plans and risk assessments were not always in place or reviewed and updated regularly. Where monitoring records were in place these were not always completed.

Medicines were not always managed safely. Medicines audits had failed to identify that medicated creams and powders had been left out in people’s rooms, were not always dated when opened and staff had not received training to apply medicated creams. People’s allergies had not always been recorded in their care records.

We were not assured people were cared for by staff that had received mandatory training or training updates regularly. Staff were not always supported with regular supervisions and appraisal.

However, people told us they felt safe, staff knew how to care for them well and other risks to people such as, people at risk of falling or not having adequate nutrition and hydration were being managed well and advice was being sought when needed. There were enough staff available to care for people and staff were recruited safely.

We identified one breach of the legal regulations.

The registered manager and provider did not demonstrate good understanding of the Mental Capacity Act 2005 and how to apply it to protect people’s right to be included in decisions about their care. Mental capacity assessments and best interests decisions had not always taken place where people had restrictions placed on them according to the law.

The systems and processes in place did not always ensure people’s care records were up to date which increased the risks to people of receiving inconsistent support.

People and their relatives told us staff responded promptly to people’s health needs. Staff knew people well and understood how to care for them in line with their preferences and choices.

People’s records contained information from health professionals involved in their care and we observed staff supporting people safely.

We identified one breach of the legal regulations.

The provider failed to have effective systems in place to assess, monitor and improve the quality and safety of the service. Systems to assess and monitor medicines, risk management, infection prevention and control, application of the Mental Capacity Act 2005, staff training and environment safety had not identified or effectively addressed the concerns found during the assessment.

Staff were supported to raise concerns, were positive about the registered manager and told us the registered manager and provider were approachable. However, some staff felt the current management arrangements were not ensuring the service was well led.

Feedback from health professionals visiting the service was positive about staff and the registered manager and they said people had access to healthcare support when required.