Background to this inspection
Updated
26 March 2019
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection site visit started on 8 January 2019 and was unannounced. The inspection continued on 10 January 2019 and was announced. The inspection was carried out by two inspectors on the first day and by an inspector and assistant inspector on the second day. We brought forward this inspection as we had received concerns about the management of falls, staffing and leadership of the service.
Before the inspection we reviewed all the information we held about the service. We did not request a Provider Information Return. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We gathered this information during the inspection.
During the inspection we spoke with seven people who used the service, one visitor and two relatives. We also spoke with five members of staff, the provider, registered manager and cook. We spoke with three professionals who had knowledge of the service. Some people were unable to share their experience of the service with us, so we spent time observing their day.
We looked at a range of records during the inspection, these included five care records. We also asked to see other records such as supervision, and information relating to the management of the service including quality assurance audits, health and safety records, policies, risk assessments, and staff training records. We looked at five staff files and the recruitment process. Some of these records requested were not available for us to view as the provider had not maintained their records.
We requested that the registered manager send us a further information in regards recruitment and their Statement of Purpose by the 14 January 2019. This information was sent to us as requested.
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 from harm. The service did not always provide staff that had the right mix of skills, competence or experience to support people to stay safe. Staff had not completed induction training, or had not been kept up to date with training the service deemed essential.
Staff had not had individual supervision or had their competencies assessed. New staff informed us they had not had the opportunity to read people's care plans before supporting them, but had a good knowledge of their needs which they had gained from working with other staff.
People were not safeguarded against the risk of being cared for by staff that were unsuitable to work in a care home. The staff recruitment files evidenced, and staff informed us, they started work before suitable checks had taken place such as the Disclosure and Barring Service (DBS), which includes criminal records checks. Files did not contain reference checks or previous employment histories.
People were not involved in day to day decisions about their care and treatment and staff lacked knowledge about the importance and guidance around making a decision in a person's best interest. Where people were deprived of their liberty, records relating to this had not been completed in line with the Mental Capacity Act 2005 (MCA). Deprivation of Liberty Safeguards (DoLS) authorisations were out of date and had not been reapplied for. People can only be deprived of their liberty so that they can receive care and treatment when this is in their best interests and legally authorised under the MCA.
People's care plans and associated records did not detail their most current care needs and some documents had not been reviewed. Where records had been reviewed, this process was not thorough and did not identify any changes. People’s preferences and choices for their end of life care were not recorded, the registered manager told us they had not considered people’s end of life wishes.
We have made a recommendation regarding involving people in end of life discussions.
The service took cultural, ethical and religious needs into consideration. People told us they had opportunities to follow their faith. People’s relatives and friends could visit the home whenever they choose. They told us staff were kind and caring. There was a complaints process in place and people and their relatives told us they would speak with the registered manager if they had any concerns.
People told us they enjoyed the food and were able to make choices in regard their meals. One person told us they liked to eat later in the day, and staff respected this wish. Where people had allergies or specific nutritional needs the staff and chef were aware.
People’s information was stored confidentially in locked areas of the home. Daily charts and basic information about people was kept in the staff office and completed by staff at intervals throughout the day.
During our inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
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.