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Inspection Summary


Overall summary & rating

Good

Updated 24 August 2018

This inspection took place on 5 June 2018 and was unannounced.

Green Trees is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Green Trees accommodates up to 16 people. On the day of the inspection, there were 14 people living at the home.

When we last inspected, we found breaches of legal requirements in relation to person centred care, assessing risks associated with people’s care, safeguarding people from abuse and not notifying CQC of important incidents.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions to at least good. At this inspection, we found that the provider had made improvements to address most of the concerns identified. However, we found that there was further improvement required to ensure people received care which met their emotional and social needs.

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.

We saw that improvements had been made to the provision of activities for people. However, we received feedback that on days when there were no activities, people were not stimulated. We also found provision had not been made to support people to access the community if that was something they wanted to do.

People told us they were well treated at the home and risks to their safety had been identified and ways to mitigate these risks had been recorded in people's care plans.

Staff were aware that the people they supported were vulnerable and they understood their responsibilities to keep people safe from potential abuse.

There were systems in place to ensure medicines were handled and stored securely and administered to people safely and appropriately.

The home maintained adequate staffing levels to support people.

We saw friendly, caring and supportive interactions between staff and people and staff knew the needs and preferences of the people using the service. Care plans were person centred and reviewed regularly.

People told us they enjoyed the food provided and that they were offered choices of what they might want to eat.

People had regular access to healthcare professionals such as doctors, dentists, chiropodists and opticians.

We saw evidence of staff induction and an on-going training programme. Staff had regular supervisions and annual appraisals. Staff were safely recruited with necessary pre-employment checks carried out.

Quality assurance processes were in place to monitor the quality of care delivered. Required statutory notifications had been submitted to CQC.

Inspection areas

Safe

Good

Updated 24 August 2018

The service had improved to good. Safeguarding processes were being followed and potential safeguarding concerns were reported to the relevant authorities. Staff were knowledgeable around what to do if they had safeguarding concerns.

The service maintained individualised risk assessments that were regularly reviewed and detailed information for safe management of the identified risks.

There was sufficient staffing and the service followed safe recruitment practices.

Medicines were safely administered and managed.

Effective

Good

Updated 24 August 2018

The service had improved to good. Staff were now supported through annual appraisals and regular supervisions. Staff received regular training.

People's nutritional and hydration needs were being met. People were happy with the food choices on offer.

Service worked very well with the GP and other health and care professionals in supporting people to maintain healthy lives.

The service complied with the Mental Capacity Act 2005.

The service used technology to maintain contemporaneous and accessible care records.

Caring

Good

Updated 24 August 2018

The service had improved to good. We observed kind and friendly interactions between staff and people. Staff demonstrated that they knew people likes, dislikes and care needs.

People were treated with dignity and respect.

Relatives told us they were involved in initial care planning, however not subsequent reviews.

Responsive

Requires improvement

Updated 24 August 2018

The service remains rated as ‘requires improvement’ in this area. We saw that further resource had been put into ensuring people had access to regular activities and stimulation. However, feedback indicated that day to day activities did not always happen.

Complaints were investigated and responded to. However, some relatives told us that they felt that they could not raise concerns with the registered manager as they would not be listened to.

Care plans were detailed, person centred and reviewed regularly as and when people’s needs changed.

People were supported to have a dignified and pain free death.

Well-led

Good

Updated 24 August 2018

The service was now well-led. The provider appropriately notified CQC of required statutory notifications.

We received positive feedback regarding the care people received at Green Trees. However, some relatives raised concerns regarding a lack of activities and the attitude of the management team when concerns were raised.

Staff spoke positively of the support they received from the management team.

The service had systems for assessing and monitoring the quality and safety of the service.