Updated 23 July 2025
Date of Assessment: 20 August 2025 to 21 August 2025. Pine Tree Court Care Home is a nursing home providing support for up to 40 older adults. At the time of inspection there were 27 people living at the service, some of whom were living with dementia and/or learning disabilities. At the time of the inspection there was no registered manager, and the service was being overseen by 2 new managers. The assessment was triggered by intelligence we received regarding concerns around safeguarding. An assessment has been undertaken of a service that is used by autistic people or people with a learning disability but is not registered as a specialist service. We have assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities which most people take for granted.
The provider was previously in breach of regulations relating to recruitment and infection control measures. Improvements were found at this inspection, and the provider was no longer in breach of these regulations. The provider had good governance and oversight of the service, however further improvements to managing safeguarding concerns is needed. Risk assessments and mental capacity assessments were in place. The service was adequately staffed.
However, we found the service was not always upholding person-centred care, ensuring people’s preferences were sought and documented and we found some improvements were needed with medicines management. We found staff did not always receive training appropriate to their role, for example, staff were not trained in supporting people with learning disabilities. Skills taught during training for dementia care, person-centred care and challenging behaviour was not evident when we observed interactions between people and staff, with staff unable to support people who were distressed. Staff were observed focussing on care tasks and not providing adequate emotional support for people. We found the provider was not aware of, or supporting people, under the ‘Right support, right care, right culture’ guidance, to ensure people with a learning disability were being supported in line with best practice. The provider was unaware of this guidance, putting people at risk of not receiving personalised care and treatment in line with the statutory guidance. People were also not supported to discuss their preference for having vaccinations in line with the regulation. This meant people were not always cared for in a person-centred way and the provider was in breach of the legal regulation relating to person-centred care.
We have asked the provider for an action plan in response to some of the concerns found at this assessment.