Pear Tree Residential Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of the legal regulation in relation to capacity and consent.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

People did not always have their identified needs reflected in their care plans, and the associated risks to them were not consistently assessed. For example, the registered manager and staff told us about 2 people who could become distressed due to their dementia. However, there was no care plan or risk assessment in place to guide staff on how best to support these people.

People’s needs were not consistently reviewed or updated, including following incidents or any changes in their presentation. Care plans did not always evidence that people’s views and the views of those important to them had been considered.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

People received care from staff who knew them well. However, records did not always evidence that care was meeting people’s needs. For example, for one person at risk of dehydration, fluid intake and urinary output was not monitored throughout the day. We could not be assured that fluids were being offered and encouraged frequently as this was not recorded.

Records did not show recommendations from visiting health professionals were followed and actioned by staff.

It was not always clear from records that people’s food was prepared appropriately where they had swallowing difficulties and therefore at risk of choking. We saw no evidence that staff had received training on how to support people with swallowing difficulties, in line with IDSSI guidance (International Dysphagia Diet Standardisation Initiative).

The provider did not always evidence how they worked well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

Care plans and risk assessments were not always in place or up to date to support and guide staff on the best way to care for people. Staff used a daily communication book to share information; however, action was not always taken or recorded to follow up on the information shared.

Referrals were made appropriately to external healthcare professionals, and staff supported visits from visiting health professionals during our assessment of the service.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

Staff knew the people they supported well, but documentation lacked sufficient detail on how staff proactively promoted people’s health and wellbeing. Meals for some people were not always nutritionally balanced, and people did not always receive food that matched their nutritional needs. As a result, the quality and suitability of meals varied, and some people did not consistently get the type of food they required.

A new activities coordinator had recently started and was looking to increase the physical activities available to people.

We saw regular reviews and appointments with health professionals such as dentist, opticians, GPs, Physiotherapist and Chiropodists. One person told us they were unable to do the exercises directed by the physiotherapist as they didn’t have the right armchair in their bedroom. This was shared this with the registered manager on the first day of assessment, who told us they had since provided the chair when this was needed.

Another person told us, “Staff are great, they do exercises with me. These were given to me by the stroke nurses and every day staff will say – ‘c’mon let's do you exercises.”

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Staff did not always use the Malnutrition Universal Screening Tool (MUST) to assess and monitor people’s nutritional risks. MUST assessments were not always completed or reviewed in line with national guidance, and several records did not contain up to date information on people’s weight to identify and address risk. One person required monthly MUST assessments; however, these had not been completed for over four months.

At the previous assessment, we identified concerns regarding the monitoring of people’s care. During this assessment, we found the same issues remained. For example, there was a continued lack of recording for fluid intake and output for people with a catheter.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

Mental capacity assessments and best interest decisions were not always in place as required and families had not been consulted around some decisions made for people lacking capacity. Where assessments were in place, these contained limited information and so we could not be assured that the principles of the Mental Capacity Act had been followed.

People were not clear about their rights to leave the home freely where they were safe and able to do so, we raised this with the registered manager who said they would speak to the person to clarify this.

Only 7 of the 25 staff had completed the mandatory training around the Mental Capacity Act. Information around legal restrictions or Deprivation of Liberty Safeguards, that people were subject to was not readily available to staff.

We saw staff gaining consent from people before supporting them.