Archived: Treetops Care Home

Updated 26 January 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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 was prompted in part by notification of a reduction of staffing levels by the registered provider and insufficient staff available to meet people’s care and support needs safely and to an appropriate standard. Furthermore, concerns were raised about the financial viability of the service and the impact this had on the service and the smooth operational running of the service. This inspection examined those risks.

This inspection took place on 15, 16 August 2017, 18, 19 September 2017 and 6 October 2017. It was unannounced.

The inspection team consisted of five inspectors involved over the five days of the inspection. On the first day of inspection an expert by experience attended. An expert by experience is a person who has personal experience of caring for older people and people living with dementia.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with fourteen people who used the service, eight people’s relatives, twelve members of staff, the registered manager, the external consultant who was the provider’s representative and the provider’s Nominated Individual (this person is also a Director of Epping Care Home’s Limited).

We looked at care, maintenance and staff records. This included staff rosters and records relating to the services call alarm facility. We also looked at safeguarding alerts and information relating to the financial viability of the service.

Updated 26 January 2018

At the previous inspection in June 2017 we rated the service as Requires Improvement and identified concerns around leadership, oversight, management of risks and safe staffing. This inspection was undertaken on the 15 and 16 August 2017, but due to ongoing concerns we returned again on 18 and 19 September 2017 and again on 6 October 2017. The visits were prompted by and continued because of ongoing concerns about staffing levels, competency and skills resulting in an inability to consistently and safety meet people’s care and support needs. Concerns had also been raised about the financial viability of the service and the impact this had on the service to operate safely.

We have not reviewed all aspects of each Key Question but given the risks and ongoing concerns consider it appropriate to provide as much information as possible in this report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

In this case we took immediate urgent action to restrict new admissions and impose conditions to force improvement at the service. Despite support from Essex County Council and other health care professionals over the last few months required improvements were not made. Essex County Council have since supported all those living at Treetops to move to alternative accommodation. The home has been empty since 13 October 2017.

Prior to and during this inspection we identified incidents where people may have been exposed to the risks of avoidable harm. The Commission is currently making further enquiries into the circumstances of these incidents to consider whether it should take further action under its criminal enforcement powers. We will report on the outcome of these enquiries once they are concluded.

During this inspection, we found that the registered provider was in breach of multiple regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We found that the quality of care at Treetops had significantly deteriorated and there were major concerns from people, families, commissioners of care and health care professionals about the ability of the registered provider to carry on the service without people being at potential risk of harm.

Treetops Care Home provides accommodation and personal care for up to 52 older people. There were 36 people living at the service in August 2017 and on our return in September 2017 there were 30. Those accommodated at Treetops are vulnerable due to their age and frailty, and in some cases have specific and complex needs, including dementia, mental health and physical disabilities.

A registered manager was in post at the time of this inspection. 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.

The provider was unable to demonstrate that a reduction of staff was appropriate to meet the needs of people using the service and keep them safe at all times. Additionally, the service had a shortfall of permanent staff and was reliant on external agencies to cover shifts. The availability of agency staff was restricted because the provider had not settled invoices and outstanding monies. This at times meant that some shifts were not covered as required and impacted on staff ability to meet people’s needs.

At the time of this inspection, the provider’s nominated individual (NI) was unable to demonstrate any contingency plans to mitigate any future risk of understaffing. They were also unable to provide a clear explanation as to how they intended to manage the current debts so as to ensure people at the service were not affected.

The Commission and other health and social care professionals observed and found a significant number of medication errors, omissions, accidents, incidents and poor practice. These incidents continued to be reported by the service, health and social care professionals, relatives and others throughout August and September 2017. As a result Essex County Council and health care professionals made regular visits and provided support to the senior leadership to try and mitigate the risks. However whilst this did have some impact it was not sustainable and the provider had no strategy to robustly address the root causes and improve the service. The quality of care remained poor, incidents continued to occur which placed people at risk of actual or potential risk of harm.

The provider was unable to demonstrate that they had the ability to ensure people in their care were safe. The infrastructure in place to support senior management and staff teams was significantly lacking. Resources were not easily available to ensure that improvements could be made and sustained. For example we found the main lift had broken down regularly over a two year period, the alternative platform lift was found to be unsuitable and unsafe for people to use. This was because it also stopped working and had entrapped people who had to wait for an engineer to be released.

People using the service and their relatives told us that they were not happy with the service. Concerns included poor care provision, not being provided with enough to drink and some staff not treating them with respect and dignity.