Pear Tree Residential Care Home

Updated 7 October 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Two inspectors carried out this inspection. An Expert by Experience supported the inspection, making telephone calls to people’s relatives. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Pear Tree Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Pear Tree residential home is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

During the inspection we spoke with eight members of staff. This included the nominated individual, the registered manager and care staff. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We spoke with nine people who lived at the service. We made telephone calls to ten relatives.

We reviewed a range of records. This included people’s care records and their medication records. We looked at two staff files in relation to recruitment and further staff training and competency records. We reviewed a variety of records in relation to the management of medicines. On the second day of inspection the service was short staffed, and the nominated individual was covering a shift, so we agreed to review further documentation off site. We continued to seek clarification from the provider to validate evidence found. We looked at training data and records in relation to management of the service including policies and procedures.

Updated 7 October 2022

About the service

Pear Tree Residential Care Home is a residential care home providing accommodation and personal care to up to 21 people. The service provides support to people living with dementia and older people. At the time of our inspection there were 18 people using the service.

People’s experience of using this service and what we found

Governance systems were not effective; systems and processes had failed to identify and improve the quality and safety of the service. The provider had failed to make improvements to ensure the home was well-led. The provider has been rated requires improvement within the key question well-led, at the previous six inspections.

The provider failed to seek and act on feedback from stakeholders. When feedback had been received through different process such as complaints, letters, and external concerns, the provider had failed to consider and use this information to improve the service for people.

Risks to people were not always effectively mitigated. Risks in relation to fire safety had not been addressed as fire doors were routinely wedged open and did not all fully close to protect people from the risk of fire. This had been raised to the provider by external agencies on two occasions, but no action had been taken to mitigate risks. Infection control processes were not robust. We observed poor practice in relation to the wearing and storage of PPE and the cleaning of the home.

People did not always receive person centred care. There was a lack of activities and engagement to meet people’s social needs and provide them with stimulation. People had made requests to improve their quality of life such as staff name badges to enable them to remember people names, but these had not been considered and acted on.

There was not always sufficient staff on shift, this included staff to provide activities and domestic duties. Staffing levels were not always provided in line with the numbers of staff required. The providers training matrix did not assure us that staff had received the required training to meet people’s needs.

We received mixed feedback about the quality of food. We have made a recommendation regarding this.

People told us they felt safe at the service and staff told us they were confident to report any allegations of abuse. Relatives were mainly positive about the support people received.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, records of consent were not always in place. We have made a recommendation about this.

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

Rating at last inspection

The last rating for this service was good (published 03 June 2021).

At our last inspection we recommended that provider seek advice about reviewing and updating their governance systems. At this inspection we found the provider had not made improvements in relation to their governance systems.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Following a review of information held we identified concerns in relation to risk management and governance. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. During the inspection we identified concerns in relation to staff training, so we opened up the inspection to include the effective domain.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Pear Tree Residential Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to risk management, staffing, person centred care and governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.