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Archived: TreeTops Residential Care Home Requires improvement

Inspection Summary

Overall summary & rating

Requires improvement

Updated 26 March 2019

This inspection took place on 8 January 2019 and was unannounced. The inspection continued on 10 January 2019 and was announced.

TreeTops is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

TreeTops is registered to provide accommodation and residential care for up to 18 people. At the time of our inspection there were seven people living at the home, some of whom were living with a diagnosis of dementia. The home is set out over three floors. Access to the first floor is by stairs or chair lift. The ground floor provides access to a secure garden area. The third floor was not in use at the time of our inspection.

This inspection was brought forward because concerns had been expressed about the safety of people living at the service. We shared those concerns with the local authority and the fire service.

There was a registered manager 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.

Quality monitoring and audits had not been completed which meant areas of the service being provided were not meeting the requirements of the regulations. There was a lack of consistent and effective management and leadership, which coupled with ineffective quality assurance systems meant issues were not identified or resolved.

There was inadequate information about people's risk of falls as records relating to this did not contain sufficient detail. Where people were at risk of falls staff tried to encourage them to remain seated unless supported by staff. Risk assessments for people's individual care needs were not accurate and lacked detail. Systems in place did not always consider the least restrictive options, which put people at risk of losing their independence and freedom of movement.

Serious incidents had not been reported to the appropriate authorities. Accidents and incidents were not fully documented and followed up on continuing risk.

Managing risk in regard to the safety of the home was not robust. Fire safety checks such as weekly alarm testing had not taken place since October 2017, and new staff had not received fire training. Following our inspection, we made an immediate referral to the Fire safety team who have since visited the service. Essential checks on the safety of water temperatures were not in place, this meant there was a risk of legionella.

People did not always receive their medicines safely by staff who had been trained to administer them. Staff were not always clear about their responsibilities and role in relation to medicines. People were not encouraged to remain independent in the management of their medicines. Lessons were not always learnt or shared with staff when errors occurred. When health care professionals had given the provider specific instructions on how to care and support people, these were not consistently followed putting people at risk of unsafe or inappropriate care

Policies and procedures in relation to infection control and fire were not up to date or being monitored by the provider. Measures to prevent and reduce the risk of infection control had not always been taken. Staff did not always wear Personal Protective Equipment [PPE] such as gloves and aprons when supporting people with personal care or dealing with soiled laundry. Staff were unable to explain how to ensure people remained safe from infection spreading within the home. Staff had not received infection control training, or their training they had previously received was out of date.

Systems, processes and practices did not keep people safe

Inspection areas


Requires improvement

Updated 26 March 2019

The service was not always safe.

People were at risk as accidents and incidents were not analysed to reduce risks.

People were at risk as recruitment processes were not safe. The provider had not completed full employment checks before staff began to work with people.

People were not safe in regards the administration of their medicines as some staff had not received the relevant training or competencies checks.

People were not protected from the risk of infection as staff did not follow infection control good practice.

Staff understood the signs of abuse and how to raise concerns.

Lessons were not learned and shared amongst the team. When errors occurred, professional guidance was not followed.


Requires improvement

Updated 26 March 2019

The service was not always effective

People's rights were not respected under the Mental Capacity Act 2005.

People�s Deprivation of Liberty authorisations had expired and applications had not been made in advance of the expiry date.

People were supported by staff who had not received training to ensure they had the correct knowledge and skills to meet their needs.

People were supported by staff who did not receive regular support or supervisions.

People could choose what to eat from a choice of freshly prepared food.

People had access to external healthcare professionals when they needed them.


Requires improvement

Updated 26 March 2019

The service was not always caring

People were treated with dignity, but were not always spoken to in a respectful manner.

People�s information was stored confidentially in locked areas of the home.

People and their relatives spoke highly of the staff supporting them and told us they knew staff well.


Requires improvement

Updated 26 March 2019

The service was not always responsive.

People were not always provided with information in formats that helped them to communicate their needs.

People and families were not involved in reviewing their care and support.

People�s care plans were not updated and did not reflect people�s changing needs.

People did not have access to activities which met their preferences or their needs.

People and their relatives told us they knew how to make a complaint and would feel comfortable making complaints.



Updated 26 March 2019

The service was not well led

Systems for identifying and managing risks were ineffective. People remained at risk in the event of an emergency evacuation as records were not up to date.

The provider did not ensure that audits were maintained and records kept up to date to monitor the quality of the service.

Notifications were not sent with the Care Quality Commission as legally required.

Leadership was visible and the management promoted an open-door approach.