Archived: Treetops Care Home

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.

This inspection was undertaken on 21, 22 and 23 June 2017.

Treetops Care Home provides accommodation and personal care to up to 52 people. People living in the service may have care needs associated with dementia. There were 35 people living at the service on the day of our inspection.

At the time of this inspection a registered manager was not in post. A manager had been appointed in July 2016 and was in the process of making an application for registration with the commission. The process was completed soon after the inspection and the manager is now registered. 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.

At our last inspection of the service in October 2016, we judged that improvements were needed to management and quality systems. At this inspection, we found that the service was not well led and there were continued weaknesses in the provider’s approach to monitoring, improving and sustaining the quality of the service. Risk management plans were not always in place or kept up-to-date or adhered to so as to support people and keep them safe. Accurate records were not consistently available to identify and to guide staff on how to meet people's assessed care needs. Where guidance was available, staff did not always know about it or put it into everyday practice. Attention was needed to ensure that people consistently had sufficient drinks of their choice and nutritional input that meet their needs. People did not always have the opportunity to participate in social activities and engage in positive interactions to ensure person centred care. Staff induction, training, support and competence assessment procedures were limited. There was a lack of active staff supervision and direction.

Improvements were needed to ensure that up to date guidance and procedures about protecting people’s rights and safeguarding them was implemented. The service also needed to ensure that all of the people living there were routinely cared for in a way that respected their dignity.

People’s medicines were safely managed. Arrangements were in place to support people to gain access to health professionals and services.

People felt able to raise any complaints and felt that the provider would listen to them. Information to help them to make a complaint was readily available. People living and working in the service had the opportunity to say how they felt about the home and the service it provided and be listened to.

You can see what action we told the provider to take at the back of the full version of the report.

This unannounced comprehensive inspection took place on 10 and 11 October 2016. Our observations at this inspection showed that significant improvements had been made to the safety and quality of the service people received. People’s care was assessed and planned for.

Treetops Care Home provides accommodation for up to 26 older people who require personal care. People may also have needs associated with dementia. There were 20 people living at the service on the day of our inspection, including one person who was in hospital.

A registered manager was not 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.

Since our last inspection, a manager was appointed and registered with the commission; however they had subsequently voluntarily cancelled their registration with us. A new manager was in post and undergoing a probationary period to ensure their suitability for the role. They confirmed they would take steps to progress an application for registration as required subject to successfully completing their probation.

While improvements had been achieved in the service throughout, some further progress was needed to the way the service monitored these to ensure they were maintained. This included the organisation, maintenance and safekeeping of records at all times. The provider’s representative showed us that this was ready to implement.

Staff were knowledgeable about identifying abuse and how to report it to safeguard people. Recruitment procedures were thorough. Risk management plans were in place to support people and keep them safe. There were also processes in place to manage any risks in relation to the running of the service. Medicines were safely stored and administered in line with current guidance to ensure people received their prescribed medicines.

People were supported by staff who knew them well and were available in sufficient numbers to meet people's needs effectively. Staff received ongoing training and used their training effectively to support people. Staff understood and complied with the requirements of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards.

People had regular access to healthcare professionals. A wide choice of food and drinks was available to people that reflected their nutritional needs and took into account their personal preferences.

People were well cared for by kind and caring staff who treated them with dignity and respect. Visitors were welcomed and relationships were supported.

People’s care was planned and reviewed with them or the person acting on their behalf. This made sure that people’s preferences were included and that staff had information on how best to meet people’s needs. People were supported to participate in social activities that interested them and met their needs.

People felt able to raise any complaints and were sure they would be listened to. Information to help them to make a complaint was readily available.

There was an open and inclusive approach in the service. People had opportunity to express their views on the service and influence improvements.

We looked at records relating to staff training and support. We also looked at policies and any checks the provider and the manager had in place to monitor the quality of the service.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

People were protected from the risk of infection because appropriate guidance had been followed.

Some staff had been provided with training in infection control, moving and handling and fire safety.

However, records showed that many of the staff had not completed training in moving and handling and health and safety. This meant that those staff were not provided with the information that they needed to ensure that people were safeguarded.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the staff training and support.

Is the service effective?

People's care records showed that, in general, care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. However, people's care records were not always personalised, consistently recorded and up to date. This meant that staff were not provided with current information about how people's needs were to be met safely and effectively.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the care records, and the improvements they will make in relation to their consistency and completeness.

Is the service caring?

We noted that staff were kind and caring towards people who used the service. Staff spoke with people by name and interacted with them in a friendly and respectful way. People who used the service also knew the staff by name.

One person said, 'I have no complaints about the staff or the care. The staff are all very good.'

Is the service responsive?

We saw that staff respected and responded to people's choices in relation to food, drinks or where they wished to spend their time.

One person told us that staff responded to their needs and choices and said, 'Staff always take me downstairs in the lift when I want to, especially for the hairdresser, there are never any problems.'

Is the service well-led?

We saw that some of the areas of improvements identified as required at our last inspection, such as in relation to management of infection, had been made.

The manager was not able to demonstrate however that they, and the provider, had suitable systems in place to assess and monitor the quality of the service provided to ensure people's safety and well-being.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance.

We had received information about the service prior to our inspection that included concerns about management of infection at the service. During our inspection we identified areas of concern in relation to staff training and record-keeping. We included these in our inspection.

We found overall that people experienced care and support that met their needs. We spoke with two relatives and four people who used the service. One person told us, "I am very happy, I have been here for two and a half years, I have lots of visitors." A relative said, "As a family we are pretty impressed overall, can't really fault the place", Mum always speaks positively about her life here."

We found that effective systems were not in place to reduce the risk and spread of infection.

We found that there were enough staff to meet the needs of people living at the home at the time of our inspection.

Effective recruitment and selection processes were in place and checks were undertaken on staff before they started working at the service. However, staff were not always trained to deliver care safely and to an appropriate standard.

People who used the service and staff were asked for their views, a noted improvement from our last inspection. However systems to ensure the safety and quality of the service were not effective.

People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.

We found that people's care was not always planned for and implemented in a way that consistently met their individual needs. We spoke with a healthcare professional told us that staff were very helpful no matter how stretched they were, that they referred people promptly for treatment and followed verbal instructions to support people's care and treatment.

The provider could not show us any evidence that checks had been completed on recently recruited staff before they started working at the home.

We found that there were not enough qualified, skilled and experienced staff to meet people's needs at all times. People we spoke with told us that staff worked very hard but most people told us there were not enough staff to meet people's needs consistently.

The provider did not have an effective system in place to gain the views of people who used the service and to identify, assess and manage the risks to the health, safety and welfare of people using the service and others.