Archived: Treetops

During this inspection we checked that the provider was meeting the legal requirements of the regulations they had previously breached. You can read the report from our last inspections, by selecting the 'All reports' link for, Treetops on our website at www.cqc.org.uk

Treetops is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Treetops can provide care and support for up to 24 older people, some whom are living with dementia. At the time of our inspection there were 15 people living at the service.

The service provides accommodation in purpose built premises. The service is on ground floor level and has three separate areas. Maple, Holly and Ash. Each area has a lounge and kitchen area. There was a communal activity room and two garden areas.

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. Each manager was responsible for a number of services.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements had been made and is no longer rated inadequate in any of the key questions. Therefore, this service is now out of Special Measures.

Since our last inspection the service had made improvements and was now meeting the regulations previously breached. Consent to care and treatment was sought in accordance with the Mental Capacity Act (MCA) 2005. Systems to monitor and review the quality of care had been improved so that records were accurate and issues were identified promptly so appropriate actions could be taken.

Staffing numbers were at a consistently safe level. However, the service continued to use a high proportion of agency staff, both for nursing and care staff. This impacted on people as they were often supported by staff who were unfamiliar to them. It also affected the staff team morale and teamwork.

Risk assessments identified potential risks to people. Guidance was clear for staff on how to support people safely and reduce risks. People’s independence was promoted through positive risk assessments and care planning.

Staff received an induction, training and regular supervision to support them in their roles. Staff spoke positively about the training offered by the service and the support they received.

People were supported by staff who were kind and caring. The atmosphere was calm and relaxed. Visitors were welcomed at the service and encouraged to engage and provide feedback about the care and support provided.

Care plans had improved to provide consistent information about people’s backgrounds, preferences and routines. Strategies were in place to guide staff on how to support people effectively.

People were supported with their nutrition, hydration and healthcare needs. Applications were made when appropriate in relation to the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the capacity to consent to treatment or care or need protecting from harm.

There were activities available for people. People and relatives felt comfortable in raising any concerns or complaints. Actions were taken as a result promptly.

Improvements were being made in the internal decoration and external areas of the service. The service was clean and tidy and infection control policies and procedures were adhered to. Regular checks of the environment, equipment and fire safety were undertaken.

In March 2017 a focused inspection of the service was conducted to check if the service had met the requirements of the warning notice in relation to Regulation 11, consent to care. We found at this time the service was compliant in this area. However, at this inspection we found these improvements had not been sustained.

At this inspection we checked if the service had complied with the warning notice in relation to Regulation 17 good governance. We found that the provider had not met the warning notice and had not met the requirements of this regulation.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

You can read the report from our last comprehensive inspection, by selecting the 'All reports' link for Treetops, on our website at www.cqc.org.uk

Treetops is a care home with nursing for up to 24 people. The service provides support for older people who are living with dementia. At the time of our inspection there were 19 people living at the service.

The registered managed had left the service since our last inspection and an interim manager was in place whilst a new registered manager was being recruited. The interim manager had submitted their application to be registered with the Care Quality Commission. 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 service was not well-led. The management of the service had seen several changes. The instability of management had impacted on changes being implemented and sustained. We found the provider had not fully met the warning notice in regards to good governance that had been issued following the inspection in January 2017. The staffing at the service consisted of a high number of agency staff. All nursing hours were delivered by agency staff. These issues have been highlighted to the provider at previous inspections.

Capacity assessments and best interest decisions, when needed, were not always made in accordance with the MCA. Documentation to support this was not always fully completed or accurate to ensure compliance with the MCA. This has been highlighted to the provider at previous inspections. Complete and accurate records in relation to repositioning, safeguarding and risk assessments were not always kept. Induction records were not available for all staff members to demonstrate what areas staff had been orientated in before they commenced their role. Quality surveys were completed with people and relatives but actions had not been taken as a result.

Medicines were stored and disposed of appropriately. However, the recording and monitoring of people’s medicines needed further improvements. Risk assessments and guidance was in place for staff on risk management. However, some specific information in people’s risk assessments was not always consistent.

Incident and accidents were reported and recorded. Actions were taken to reduce the risk of reoccurrence. Staff knew how to identify and report safeguarding concerns. Regular checks of equipment and the environment were undertaken.

Staff received regular supervision and training to support them in their roles. Mealtimes were calm and relaxed and people received the support and assistance they required. Staff supported people with their food and fluid intake and escalated concerns when needed. People had good access to healthcare and improved systems had been introduced in this area.

Applications were made when appropriate in relation to the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the capacity to consent to treatment or care or need protecting from harm.

People were supported by staff who were kind, caring and respectful. People and relatives spoke positively about staff at the service. People’s privacy and dignity was maintained. People were supported with their individual choices. The atmosphere was calm, friendly and relaxed. People said they felt comfortable in raising any concerns. Visitors were welcomed at the service.

Activities were provided within the service. People told us they could choose how they spent their time. Care plans contained details about people’s personal histories and backgrounds. However, we found that some care plans did not always contain information consistently.

Improvements had been made in the service’s communication with staff, relatives and health professionals. Through handovers, meetings and guidelines. Information and direction for agency staff members was available.

We found two breaches 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 this report.

We undertook a focused inspection on 30 March 2017 to check the provider was meeting the legal requirements of the regulation they had breached and had complied with the Warning Notice. This report only covers our findings in relation to this area. You can read the report from our last comprehensive and focused inspections, by selecting the 'All reports' link for ‘Treetops’ on our website at www.cqc.org.uk

Treetops is a care home with nursing for up to 24 people. The home mainly provides support for older people who are living with dementia. There were 21 people living at Treetops at the time of our inspection.

A new manager had started in post in December 2016. They were not yet registered at the time of our inspection with the Care Quality Commission. 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 this inspection, we found the provider had taken action to comply with the Warning Notice.

Capacity assessments had been completed where people may be unable to make a particular decision about their care and support. Associated best interest decisions had been made to ensure this was the least restrictive option available.

Records in relation to people’s capacity still showed inconsistencies which made it unclear if people had capacity or not in particular areas of their care and support. This area of work requires further development.

Treetops is a care home with nursing for up to 24 people. The service provides support for older people who are living with dementia. At the time of our inspection there were 22 people living at the service.

The service had been without a registered manager since March 2016. A newly appointed manager had recently commenced in post, they were not yet registered with the Commission. 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 service was still reliant on the use of agency staff. Whilst permanent staffing levels had improved it meant that non permanent staff did not always know people or the systems of the service well. Staff did not always feel valued in their role and were not always supported effectively through regular supervisions.

Applications were made when appropriate in relation to the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the capacity to consent to treatment or care or need protecting from harm. However, we found that the conditions set out in people’s DoLS authorisations were not always being met. Capacity assessments and best interest decisions, when needed, were not always made in accordance with the MCA. Documentation to support this was not always completed or accurate to ensure compliance with the MCA.

Care plans were not person centred. They were not always fully completed, accurate, or consistent. This also applied to the recording of incident and accidents, healthcare needs and induction records. Risks and support needs were identified but there was not always sufficient guidance on how to support people safely and effectively.

Since our previous inspection the structure and facilitation of activities had improved, although there was feedback that some people were not always stimulated enough.

People and relatives had access to the complaints procedures and said they felt comfortable in raising concerns. However, we found that changes necessary in response to issues raised were not always maintained or completed.

The home was not adequately managed. Changes the provider had outlined in their action plans in response to our previous inspections had not been sufficiently monitored or completed. This meant that improvements required throughout the service had not been achieved. Systems in place to monitor the quality of the service were not always effective as whilst areas had been identified as requiring improvements, necessary changes had not been implemented.

The service was caring and people were supported by staff that were kind and respectful. We observed positive interactions and relationships between staff and people living at the service. We received positive feedback from people and relatives about staff members. People’s visitors were welcomed at the service at any time.

Notifications were now being submitted to the Commission and other agencies, such as the local authority safeguarding team when necessary.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have made a recommendation in regards to people’s fluid and nutrition and also in regards to providing effective supervision to staff members. You can see what action we told the provider to take at the back of this report.

We undertook an unannounced inspection of Treetops on 12 April 2016. Treetops is a care home with nursing for up to 24 people. The home mainly provides support for older people who are living with dementia. There were 20 people living at Treetops at the time of our inspection.

At the time of the inspection the home did not have 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 said they felt safe living at Treetops. Risk assessments for people were in place but these did not always provide sufficient guidance for staff about how to manage the risks. Medicines were managed safely however, there were recording omissions.

Safe recruitment procedures were in place and new staff completed a full induction aligned with the Care Certificate. Staff received regular training to ensure they were skilled and effective in their roles.

Staffing was in accordance with the home’s set levels. However, staffing was dependent on the use of agency staff. This meant that people did not have familiar people supporting them who knew them well.

Applications were made when appropriate in relation to the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the capacity to consent to treatment or care or need protecting from harm. However, we found that the conditions set out in people’s DoLS authorisations were not always being met. Staff understood the principles of the Mental Capacity Act 2005 and applied these in their role. However, capacity assessments and best interest decisions, when needed, were not always made in accordance with the Mental Capacity Act 2005.

The feedback from people and relatives was mostly positive about staff at the home. We observed staff being kind and treating people with dignity and respect. However, we observed that care and support was not always person centred. People’s visitors were welcomed at the home.

Care plans were not always fully completed. They were not always in an accessible format for people. They did not provide sufficient guidance for people to be supported in a person centred way.

Feedback was not sought from people or relatives through meetings or questionnaires. Staff had meetings where they were able to contribute ideas and feedback. Activities were provided in the home and community.

The home did not have a registered manager in post. There was a lack of stable management and this impacted on people and staff. Changes needed to improve the service had not been implemented. Notifications of important events had not always been sent to the Commission as required.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of this report.

We undertook a focused inspection on 1 February 2016 to check the provider was meeting the legal requirements of the regulations they had breached and had complied with the Warning Notices. This report only covers our findings in relation to these areas. You can read the report from our last comprehensive and focused inspections, by selecting the 'All reports' link for ‘Treetops’ on our website at www.cqc.org.uk

Treetops is a care home with nursing for up to 24 people. The home mainly provides support for older people who are living with dementia. There were 19 people living at Treetops at the time of our inspection.

A registered manager was in post at the time of our 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.

At this inspection, we found the provider had taken action to comply with the Warning Notices.

The garden had been made safe. Hazardous items had been removed or made safe. However regular checks were not being completed to ensure that safety issues were identified and addressed.

Improvements had been made in record keeping. Repositioning, food and fluid and personal evacuation plans were completed. However there was a lack of effective monitoring which could lead to unsafe care.

The provider sent us an action plan that detailed how they would achieve compliance with outcome 21 of the Health and Social Care Act. During this inspection we found the actions the provider told us they were planning to take, had been implemented within the service. Care plans and recording charts that we viewed were an accurate reflection of people's needs and were regularly completed.

We did not speak with people that lived in the home directly about the outcome that we were inspecting. Not all people were able to verbally tell us what it was like living in Treetops as they were living with a form of dementia. Therefore we observed how staff interacted with people in the communal areas. This was to gain an understanding of what it was like for people living in Treetops.

Staff we spoke with had a good understanding of people's needs and people appeared relaxed around staff and were interacting verbally together.

Staff we spoke with confirmed the recording processes that were now in place following our last inspection and the improvements that had been made.

We viewed the care records of four people using the service and found that these described people's needs in various aspects of their care. Information in support plans was on occasion inaccurate. We also found some gaps in daily recording and examples where food and fluid intake had not been recorded appropriately.

We saw that people were offered food that was appealing and that there was choice available. There were assessments in place to help identify people who may be at risk nutritionally. Staff had good knowledge of the dietary requirements of people in the home.

We found that there were sufficient staff on duty to support people in the home. Overall there were systems in place for the provider to monitor the quality of the service provided.

We visited the home again on 12 November 2012 to follow up the compliance actions that we made at the last inspection. Overall we found that improvements had been made and the manager told us about 'work in progress' to further develop aspects of the service.

There was better information about 'consent' and the arrangements being made if someone did not have capacity to make an informed decision. Action had been taken to help ensure that people were supported in a 'person centred' way, although there was more that could be done in this respect.

People's care plans had been updated and their records were being kept securely. Some information in the records lacked detail although the overall standard of record keeping had improved.

The people we spoke with mentioned changes that they had noticed since we last inspected the home. A relative for example thought that there was a better standard of cleanliness. One of the staff felt that as a team they were more 'focussed' in the way that they provided care to people.