Green Trees Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People and relatives told us they felt safe living at Green Trees. They felt staff understood them and understood their care and support needs. Despite this positive feedback, we found some concerns. Risk assessments did not always contain enough information to ensure staff were able to recognise and manage risks to people’s health and well being, medicines were not managed in a safe and effective way. The lack of guidance to staff on how to minimise people’s known risks and poor medicines management put people at risk of harm and meant that the service was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are also making a recommendation the provider review staff deployment to ensure adequate and appropriate staffing.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Relatives commented they felt people were safe and well cared for living at Green Trees. A person commented, “I decided I needed to come here to be safer. I'm safer here anyway, there are people around to help me.”

The registered manager and manager were aware of when to raise any safeguarding issues. Staff understood their responsibilities with regards to safeguarding and understood how to report any concerns.

There had been 3 recent safeguarding concerns which the home had engaged with the local authority safeguarding team to ensure people’s safety. There was a safeguarding policy in place which staff were aware of and staff had received safeguarding training.

Relatives constantly told us they felt their loved one’s risks were well managed and staff understood people’s needs. However, despite this positive feedback, we found concerns with how people’s risks were identified and managed.

During the inspection, the registered manger confirmed people were not involved creating risk assessments. They said this would be reviewed going forward.

We observed several manual handling procedures, where people who do not have mobility are transferred using hoists. Staff ensured people were safe and followed correct procedures when doing this.

Risk assessments were tick box format with very little information or guidance for staff on how to minimise the risk. For example, one person’s risk assessment noted they required help with showering / bathing and no information on what help was required or why. Where an assessment of falls or risk of developing a pressure ulcer had been done, there was no risk assessment in place if there were any risks identified by the assessment. Risk assessments did not provide sufficient guidance for staff on how to minimise known risks.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and relatives told us they were happy with the staff caring for people and felt they knew what they were doing.

We raised the concern around a lack of staff presence in the lounge for large parts of the morning, during our on-site visit, with the manager and registered manager. The manager said there had previously been 2 care staff on duty and that had been increased to 3 recently. The registered manager said staff were busy getting people up, arranging breakfasts and another staff member was doing medicines. Staff we spoke with felt they were of often too busy to spend time with people. One staff member said, “At the moment we are expected to do activities, teas, laundry, meds, the kitchen. In between that we prepare the breakfasts as well. The rest [people] are getting neglected whilst we are doing these other jobs, especially in their rooms” and “There used to be 2 but there have been 3 I think there are enough staff. I don’t think the carers should be doing the laundry and the dishwasher.”

We observed, during the morning, staff were not available in the communal area and people were often left for long periods of time. We observed the morning medicines round for 16 people and saw it took staff nearly 3 hours to complete this. Although the staff member doing the medicines was wearing a do not disturb tabard, they were consistently asked questions regarding other tasks.

Staff supervision was not formalised or regular. The registered manager told us they were aware that, to date, this had been an informal process, and the new manager was reviewing supervision structure and timing. Staff were recruited safely, and appropriate background checks had been completed prior to starting employment. Staff had received training and following the inspection, the provider booked further training for staff in response to some of the concerns raised during this inspection.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We observed the morning round of medicines administration. We saw people were gently encouraged and supported to take their medicines. Staff knew how people liked to take their medicines and sat with people asking if they were ready to take their tablets and then supported them appropriately,

The manger told us they had identified many of the concerns raised by the CQC pharmacist and was in the process of reviewing medicines management. The local authority had also identified similar concerns during a recent visit. The manager had created an action plan which highlighted how they were going to address the concerns.

Systems in place to manage medicines were not safe. Some of the issues identified included, lack of adequate documentation when disposing of medicines, inappropriate recording of medicines when administered, medicines not being administered in a timely manner and according to pharmacy instruction and covert medicines administered in an unsafe way. The medicines policy did not reflect what the homes guidelines were for medicines management within the home. Following the inspection, the manager told us the system of recording medicine administration had changed, and staff had an external trainer come in to retrain them in medicines management and administration. A staff member told us, “Yes, I give medicines. This new system, I’m getting there slowly.”