Green Trees Care Home

Green Trees is a 'care home' and provides accommodation and personal care for up to 16 older people. On the day of the inspection, there were 16 people living at the home.

People’s experience of using this service and what we found

People had access to healthcare services and were involved in decisions about their care. Partnerships with other agencies and health professionals enabled effective outcomes for people. Staff supported people to take medicines safely.

People's care was planned and risks to their safety and wellbeing were assessed. The service reviewed these plans regularly, involving people in these reviews and asking for their opinions.

Staff had completed safeguarding training and understood their role in identifying and reporting any concerns of potential abuse or poor practice.

People and staff praised the managers of the service and agreed that they were approachable, knowledgeable, fair and did their job well. The staff team worked well together and supported the manager.

The staff team was committed to providing a high-quality service. They had undertaken training so that they were skilled and knowledgeable to effectively meet people’s needs. Staff understood their responsibilities to report any concerns.

Staff encouraged people to be as independent as possible and respected people’s privacy and dignity.

People received care and support from a small group of staff most of whom had worked for the service for many years, which provided consistency.

People were given choices about the way in which they were cared for. Staff listened to them and knew their needs well.

Care plans contained information about each person’s individual support needs and preferences in relation to their care and we found evidence of good outcomes for people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Recruitment practices were safe and relevant checks had been completed before staff worked at the service.

The managers of the service actively sought the views of people and their relatives about the running of the service and they dealt promptly with any concerns that people raised.

The provider had systems in place to monitor and improve the quality and safety of the service provided. There was a positive culture throughout the service. Staff told us they enjoyed working at the service and felt valued.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

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Rating at last inspection

At the last inspection we rated this service Good. The report was published on 14 August 2018

Why we inspected

We carried out a comprehensive inspection of this service on 27 July 2022. This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect .

We found the following examples of good practice.

The provider had appropriate arrangements for visitors to help prevent the spread of COVID-19. All visitors were screened for symptoms of acute respiratory infection before being allowed to enter the home. They were supported to wear a face covering and maintain hand hygiene during their visit.

The service had an extensive garden area with shelter to facilitate safe visiting for families. The provider was looking at utilising indoor space with ventilation, large screens and easy clean seating to facilitate visiting in the event of adverse winter weather.

The provider was following government guidance on testing and had appropriate arrangements in place to test people and staff for COVID- 19. In the event of a positive test result, for either a staff member or person living at the service, appropriate arrangements were in place to reduce the risk of infection spreading.

The provider ensured staff received appropriate training and support to manage COVID-19. All staff had received training on COVID-19, infection control and the use of PPE. The provider liaised regularly with colleagues in the local authority and community nursing team for support and advice.

Further information is in the detailed findings below.

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.

Green Trees Care Home provides accommodation and personal care for a maximum of 16 people. It is a family owned home for older people, some of whom may have dementia. On the day of the inspection, there were 15 people using the 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.

People were not always safeguarded from abuse and avoidable harm as the provider had not notified the local safeguarding authority of safeguarding concerns. The provider did not notify CQC of two known safeguarding concerns.

Although scheduled activities took place on some days, we found that people were sitting in the lounge with little interaction or stimulation. There were sufficient staff on duty to ensure people’s needs were met, however, we observed that people were left unsupervised for periods of time. There were a number of occasions during the inspection when staff did not interact with people.

Risks associated with people's care and support needs had been identified and these had been assessed, giving staff instructions and directions on how to safely manage those risks, However, we saw that people’s risk assessments were not always followed.

There was a complaints procedure in place and complaints were investigated. However, some people told us that they did not know how to complain.

Safe medicine management systems and process were in place to ensure that people received their medicines safely and as per their needs and requirements.

Care plans were detailed and person centred and updated regularly.

All staff had received training on the Mental Capacity Act (2005) and understood the importance of obtaining consent from people. Where people’s liberty was deprived, the appropriate authorisation had been applied for which was recorded on people’s care records.

People told us that staff were caring. People told us they could choose their own routines and staff supported them to maintain their privacy and dignity.

Mealtimes were relaxed and people were offered a choice with alternatives offered.

Safe recruitment and selection procedures were in place. Staff were supported with regular training and supervisions. Annual appraisals were not documented.

People were supported to access healthcare.

Quality assurance systems were in place to monitor the safety and quality of care provided. People, relatives and staff were invited to completer an annual satisfaction survey.

Staff and resident/relative meetings did not take place.

Is the service caring?

People's needs were not always fully assessed and care and treatment was not always fully planned and delivered in line with their individual care plan. Planned activities were not available on a daily basis and there was no designated activities co-ordinator.

Is the service effective ?

Staff did not receive appropriate training, professional development, supervision and appraisal. There were no systems currently in place for regular supervision or appraisal of staff.

Is the service safe?

The provider had made suitable arrangements to ensure that equipment was properly maintained and suitable for its purpose. There were effective procedures in place for managing foreseeable emergencies. There were ineffective policies and procedures in place to protect people using the service from the risk of abuse, and from the risk and spread of infection.

Is the service responsive?

There were no formal systems in place to seek and learn from people's experiences, comments and complaints. Staff did not receive appropriate training, professional development, supervision and appraisal.

Is the service well-led?

There were ineffective systems to regularly assess and monitor the quality of the services provided, and to identify, assess and manage risks relating to the health, welfare and safety of service users and others who may be at risk. There was no evidence to support monitoring review and amendments made to policies. A proactive approach to seeking feedback about the service was not in place and feedback had not been acted upon.

We observed that people were able to move freely in the home and they appeared well cared for. People who used the service and a relative stated that personal care needs had been attended to and they had access to healthcare services. Assessments, including risk assessments had been carried out. Care plans had been prepared and these were reviewed regularly. There were suitable arrangements for the administration of medication.

The premises were clean and people were satisfied with their accommodation. Essential maintenance had been carried out and there were regular Health & Safety checks. Fire safety arrangements were in place.

There were arrangements for quality assurance and audits. A recent satisfaction survey indicated that people who used the service and their representatives were satisfied with the services provided.