Green Tree Court

Green Tree Court is a care home with nursing and is registered to provide accommodation and support for a maximum of 68 people. The service is divided into three units, Larch, Willow and Maple. Willow is designed for people living with dementia, while the other units provide for general nursing care. Both units provide long term and respite care. At the time of our inspection there were 49 people living across the three units.

Green Tree Court is a purpose-built service, registered with CQC in 2014.

People’s experience of using this service:

We identified some concerns over medicines practice. These included staff carrying out medicines practice that was not in accordance with their medicines policy, and a staff member using one person’s prescribed thickening agent to thicken another person’s drink. We also found instances where some medicines were not being clearly evaluated for their effectiveness, for example in reducing pain. No-one was harmed by these concerns, and the service’s management took immediate action to resolve them.

On the inspection, although we found staff were caring towards people, and had in many instances gone ‘above and beyond’ what would have been expected to support them, we also found some communication was not always supportive of people’s well-being. This was discussed with the management team, who took immediate action. In other instances, we saw people received positive and enhancing support from dedicated, motivated and compassionate staff.

Green Tree Court has won several high-level awards since their registration, including Care Home of the year 2018 in the National Care Awards. People living at Green Tree Court experienced a high quality environment, that was purpose built, and had been awarded a Gold Standard from Stirling University for their environment for people living with dementia. The dementia unit was calm, happy and uplifting, despite there being people there who had previously shown distressed or anxious behaviours. People had space to walk purposefully without feeling constrained or confined, and the peaceful environment contributed to their well-being. A children’s playground had been provided to encourage children to visit. The building had been designed with an awareness of their impact on the environment.

The registered manager said they wanted the service to feel ‘like a five-star hotel’, which people said was being achieved. The service had a spa, library, gymnasium, and fine dining restaurants. Rooms and communal areas were very well furnished, clean and spacious, with areas where people could help themselves to drinks, fruit and pastries throughout the day. In house therapy teams could demonstrate how they supported people’s health and well-being to improve. People’s meals were of a high quality, with restaurant style dining, or more homely presentation as people wanted.

There was an established management team at the service, with unit heads who worked alongside care staff each day. Quality assurance systems and regular audits were in place to assess, monitor and improve the quality and safety of the service provided. Effective communication systems were in place, from director level to all staff. The service was participating in research projects to help better understand and deliver exceptional care and support to people.

Risks to people from living with long term health conditions were assessed. These included risks such as from falls, poor nutrition or pressure ulcers, and included actions taken to mitigate risks where possible. People were supported and encouraged to take risks, and remain in control of their lives, supported by thoughtful and reflective practice.

Systems were in place to safeguard people from abuse, and the service responded quickly to any concerns or complaints about people’s wellbeing. Where people did not wish to follow plans to reduce risks this was clearly documented. The service learned from incidents to prevent a re-occurrence. People’s rights were being respected, and decisions had been made and recorded in people’s best interests where they were not able to make these decisions themselves. The service respected and supported individual people’s equality and diversity.

Systems for staff recruitment helped ensure potential staff were safe to work with people who may be vulnerable. High levels of staffing were in place, and this was kept under review. These and systems to ensure housekeeping staff were always available, ensured care staff were available to support people’s care needs at all times. Staff received the training and support they needed to carry out their role, including bespoke training to meet specific or complex needs.

Care plans were based on assessments of people’s needs. They contained details about people’s wishes and guided staff on how the person’s care should be delivered. We found some documentation needed minor clarification or updating, which was discussed with the head of care and nursing staff. We saw people’s care plans were being followed in practice. Staff knew people well. They understood how to support people’s communication or interpret their behaviours.

Staff told us Green Tree Court was a positive place to work, and they were well supported by the management team, who were always available or on call. Staff were very positive about working at the service, and the support they received. People were supported to continue links with the local community, and local children attended the service to be supported with their reading, or for younger children to play and interact with people living there. The service was involving people in charity fundraising. Other activities were person centred, and the service had a positive and busy atmosphere.

More information is in the full report

Rating at last inspection:

At their last inspection in December 2016 the service was rated as outstanding for the four key questions of responsive, effective, caring and well led, and good for the key question of safe.

Why we inspected: This inspection was scheduled for follow up based on the last report rating.

Follow up:

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service was registered with CQC in November 2014 and has not been inspected previously. Since registration, the service was increasing numbers to capacity in a managed, measured way to ensure people’s individual needs could be met.

There was a registered manager and two heads of care employed at the home who were clearly passionate about providing a high quality, individualised service. 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 and associated Regulations about how the service is run.

People had access to and were involved in developing personalised activities that complemented their individual hobbies and interests. Links with the local community had been established and people were supported to participate in community events and other events that were important and meaningful to them. For example, through the service partnership with the Exeter Dementia Action Alliance, foreign exchange students and local primary and secondary schools. This provided people with a sense of purpose and wellbeing. Some people used the service as respite for short periods before returning home to the community. This had become popular with people who used the home as a stepping stone following hospital procedures or to enable carers to have a break.

People and relatives were overwhelmingly positive about the care and service provided. The overall view was that the service was like a ‘caring holiday’. Comments included, “It’s like being on a cruise, so enjoyable”, “I can walk away knowing I couldn’t do better, it’s lovely to see the manager work so well with her team” and “There are high standards all the time, people are treated as people.” Reviews on the website included, “It is like a 5 star hotel, the service we have had has been faultless. Being a new building, the rooms are large and purpose built. Everything is fresh, airy and spotlessly clean”, “The home is excellent” and “I feel Green Tree [Court] is a luxury care home of very high standards, and I have been very impressed with the care received.” All reviews showed a five out of five star rating and people were ‘extremely likely’ to recommend the service.

People were supported by very kind, caring and compassionate staff who often went the extra mile to provide people with good, high quality care. This high standard of care enhanced people's quality of life and wellbeing. The staff as a whole, supported by the activities team, were extremely passionate about providing people with support that was based on their individual needs, goals and aspirations. They were pro-active in ensuring care was based on people's preferences and interests, seeking out activities in the wider community and helping people live a fulfilled life, individually and in groups.

The staff were happy working in the home and felt very supported in their role. They were clear about their individual roles and responsibilities and felt valued by the registered manager, heads of care and the wider provider, senior management team. Good leadership was demonstrated at all levels with pro-active effort to encourage ideas from staff to further benefit the people in their care and maintain a strong, stable staff team with a shared goal. Each individual staff member was engaged in sourcing new opportunities for people and putting ideas into practice.

People were safe living at Green Tree Court. There was a high staff ratio to ensure there were enough staff to meet people's care needs safely and also to provide individualised time and support in and out of the service. There was a strong culture within the home of treating people with respect. The staff and managers were always visible and listened to people and their relatives/friends, offered them choice and made them feel that they mattered. The registered manager said, “I’m so proud of this home. The staff are incredible and everything is about the person here.” Staff spent time with people to get to know them and their needs and this had ensured that behaviours that could be challenging for staff and distressing for people were minimised. Issues were identified and staff spent time with people to improve the quality of their lives and promote independence. People and the staff knew each other well and these relationships were valued. For example, the registered manager was supporting one person who they felt would benefit from returning to the community with support. The focus was on what was best for people individually to promote good quality living, reflected by the Lexicon Health Pledge (home’s aims and ethos) and staff comments during the inspection.

Staff had received appropriate training in line with nationally recognised qualifications and regular supervision to provide them with the necessary skills and knowledge to provide people with effective care. People received their medicines when they needed them.

The environment was outstanding. Each room was decorated and furnished to a very high standard. For example, specialist beds and furniture were bespoke, of a very high quality and designed to look as domestic and luxurious as possible. Premium rooms on the lower ground floor were quieter and included access to private garden spaces. The communal garden was landscaped with the safety and enjoyment of people living with dementia in mind, including safe, enclosed areas directing people in circular walks. Children’s play areas outside and inside encouraged people to spend time with their families. There were numerous communal spaces, lounges, quiet rooms, dining areas and a large decking balcony. People were able to move around the home freely or with support, enjoying the spaces. The service also provided a fully equipped professional beauty and holistic therapy room, nail bar, a physiotherapy gym and an activity room and professional hairdressing salon. A large, staffed reception area, café and snack station for residents and relatives, library, IT and learning area, shop and large wall fish tank made the entrance very welcoming.

People received a bespoke, nutritious diet and enough to eat and drink to meet their individual needs. The service ran a commercial kitchen, managed by a Hotel Services Manager and national award winning head chef, providing bespoke meals to an excellent, high standard with the support of a team of hosts and hostesses trained in customer care. Timely action was taken by knowledgeable staff when they were concerned about people's health and there were good links with local health professionals.

There were effective systems in place to monitor the quality and safety of the care provided. People felt able to raise any concerns and be confident they would be addressed. Where concerns were raised by people, relatives or through regular auditing we saw the home took them seriously and took appropriate actions to focus on learning and improvement for the benefit of the people using the service.