Neem Tree Care Limited

We found the following examples of good practice.

We found the provider followed infection prevention and control (IPC) procedures, however during the inspection we identified cupboards with cleaning products in them were not always locked. The provider took immediate action to lock the cupboards and told us how they would ensure this did not happen in the future.

Staff and people using the service had COVID-19 risk assessments and risk mitigation plans. These included people emotional needs during the pandemic. We discussed with the provider identifying more clearly potential risk indicators in the risk assessments. The provider began updating these on the day of the inspection and provided a timeline for completion.

People were supported to maintain contact with relatives and friends through tablets, phones and face to face visits. The provider had clear procedures for people visiting the service to help reduce the risk of infection spreading. This included visitors completing a form, lateral flow testing and evidence of receiving vaccinations, as appropriate. There was a designated area for taking lateral flow tests and a designated visitor room, if required.

All visitors and staff wore personal protective equipment (PPE) and we saw this was readily accessible throughout the home. We observed staff wearing and disposing of PPE correctly. Training records indicated staff had received training around infection control as well as COVID-19. Records showed that the manager or clinical lead carried out spot checks to help ensure PPE was used appropriately. We observed the home was clean and the provider followed enhanced cleaning procedures. Cleaning schedules recorded when cleaning had taken place and were reviewed weekly by a manager to help maintain a good standard of cleanliness.

The environment and layout helped to promote social distancing and rooms were well ventilated. Staff worked in the same teams in the same units to help minimise the spread of infection. People were enabled to go out and return safely to the home. This included people going out for their own reasons and people attending appointments. The provider had procedures in place to safely admit new people to the service and it was clear when people were isolating.

Everybody in the home participated in regular testing. The provider followed the government guidance and supported people to test and isolate as required. The provider responded appropriately to people with positive test results. Information was shared with relevant agencies such as the local authority and healthcare teams to help ensure people received the treatment they needed. People and staff had received vaccinations to help keep them safe.

Neem Tree Care Limited is a residential nursing home providing personal and nursing care for up to 57 older people. The service has two units dedicated to providing support to people from Asian communities, with culturally appropriate activities, a separate kitchen where only vegetarian food is prepared and a prayer room. There is one unit which accommodates people from a range of backgrounds and cultures. There is another kitchen where meat and fish are prepared for people living in this unit who wish to eat these. At the time of our inspection 53 people were living at the service.

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

People using the service and their relatives were happy and well cared for. They felt safe and liked the staff who cared for them. They described the staff as kind and attentive. We also observed this. There was a calm atmosphere, and the staff were gentle when speaking and caring for people. A large proportion of the staff were Asian and spoke the first languages of the people living at the service. They had shared cultural backgrounds and religions and were able to understand these and provide respectful care and support.

People received their medicines in a safe way and as prescribed. The staff responsible for administering medicines had been trained and assessed as competent. The nursing staff had the skills and experience needed to monitor people's health and liaise with other healthcare professionals to make sure their needs were met. People had enough to eat and drink, there were a range of different choices for each meal, including Asian food, drinks and snacks.

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

The environment and equipment being used were safe, clean, regularly checked and appropriately maintained. The provider undertook checks on fire safety, and there were evacuation plans to make sure the staff were familiar with how people should be evacuated in an emergency. The staff had assessed the risks to people's safety and wellbeing and had planned for these to minimise the risks of harm or injury. The staff supported people to move safely and were aware of how to use equipment.

There were enough suitable staff employed to keep people safe and meet their needs. The recruitment procedures included checks on their suitability and skills. Staff undertook an induction, to help familiarise themselves with the service. There was regular ongoing training and support for the staff. They told us they felt well supported and had the information they needed to care for people in a safe way.

The provider had assessed people's needs and created care plans which outlined these and the support they required. People using the service, and their relatives, had been involved in creating and reviewing these plans. The provider had responded to changes in people's needs, adjusting planned care and working with other professionals to make sure people received the right care and support. People were supported to participate in a range of different social and leisure activities. These included supporting people to pursue individual interests and feel part of the community.

People using the service, their relatives and staff liked the registered manager and found them approachable. They felt the service was well-led. They knew who to speak with if they had any complaints or concerns and felt these would be responded to appropriately. There were a range of audits and checks which helped to identify areas for improvement. The provider and management team asked others for their feedback and made improvements where needed. The registered manager analysed accidents, incidents, complaints and adverse events so that these could be learnt from to improve the service. They worked with other providers, organisations and the local authority to develop the service in line with best practice and guidance.

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

Rating at last inspection

The service was rated Good at the last inspection of 8 February 2017 (Published 31 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor intelligence 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.

We undertook this focused inspection on 8 February 2017 to check that the provider had followed their plan and to confirm that they now met the legal requirement. This report only covers our findings in relation to the Safe domain. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Neem Tree Care Limited on our website at www.cqc.org.uk.

Neem Tree Care Limited is part of Sunflower Health Care which has four homes in the North of England and Neem Tree Care in London. The home has three units over three floors and two of the floors provided support exclusively to people from an Asian background. Neem Tree Care Limited provides nursing care and support for up to 57 older people, including people with dementia. At the time of our inspection there were 49 people living at the service.

The manager was a nurse who came into post on 2 January 2017. At the time of our inspection she had applied to the Care Quality Commission to become the service’s registered manager. 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 our focused inspection on 8 February 2017, we found that the provider had followed their plan of action, dated 3 January 2017, and that the legal requirement had been met. We have looked at all the Key Lines of Enquiry (KLOE) for Safe and because the provider is now compliant with all of these, we are changing the rating to Good for the Safe domain.

Medicines were administered and managed in a safe way.

Safe recruitment procedures were in place and since the last inspection the management structure had been reorganised, new staff had been recruited and there were enough staff on duty to meet people’s needs.

Systems were in place to safeguard people from the risk of abuse and staff knew how to respond if they suspected abuse.

Risk assessments were in place to minimise identified areas of risk. Systems and equipment were serviced and maintained to keep people safe.

The last inspection took place on 29 May 2014 at which time the service was meeting the seven assessed standards.

Neem Tree Care Limited is part of Sunflower Health Care which has four homes in the North of England and Neem Tree Care in London. The home has three units over three floors and two of the floors provided support exclusively to people from an Asian background. Neem Tree Care Limited provides nursing care and support for up to 57 older people, including people with dementia. At the time of our inspection there were 49 people living at the service.

The registered manager was a nurse and had given in her notice prior to our inspection. After the inspection, the providers confirmed they had begun recruiting to the 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 found one breach of the Regulations because medicines were not always managed safely.

We saw during the inspection visit there was not always enough staff available, but after the visit, the provider had begun to recruit a full staff team and restructured the management of the service.

The service had safeguarding and whistle blowing policies. Staff had attended safeguarding training and knew how to report safeguarding concerns. Risks to people’s safety and wellbeing had been assessed to keep people safe and staff knew how to record incidents and accidents. The provider followed safe recruitment procedures.

There were a number of regular maintenance and service checks carried out to ensure the environment was safe.

People were supported to have enough to eat and drink and were able to have food and drinks when they wanted to.

People had access to health care services and the service worked with other community based agencies such as a memory clinic.

People who used the service and their relatives told us staff were kind and their dignity and privacy was respected.

A complaints procedure was available and the provider responded appropriately.

The provider had systems to monitor the quality of service delivered and to ensure the needs of the people who used the service were being met. Information was analysed and used to improve service delivery.

All stakeholders indicated they could speak to the registered manager or providers who they felt listened to them.

We found a breach 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 the full version of the report.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found:

Is the service safe?

Staff had a good understanding of the Mental Capacity Act 2005 which meant people received the appropriate support to be able to make their own decisions, or where required decisions involving appropriate people were made in the best interests of the person.

Staff were trained and responsive to any signs of abuse and avoidable harm. People reported that they felt safe and well cared for. Any risks to people were assessed and reviewed regularly to ensure people's individual needs were being met safely.

Staffing levels had been increased since the last inspection and levels were under review weekly so that people's needs could be met appropriately.

The home was clean and arrangements were in place to control and prevent infection.

Is the service effective?

New staff underwent induction training and all staff had opportunities to attend training so that they could care and support people effectively.

Staff valued people's diverse needs and were able to communicate with people in their preferred language so that people had a good understanding of their care and treatment and were able to make informed decisions.

People had access to healthcare professionals to meet their needs and the service worked well with other healthcare professionals to coordinate people's care.

Is the service caring?

During our inspection, we observed staff were caring and people were treated with dignity and respect. People told us they were happy, well cared for and treated with respect.

People were involved in their care and care plans provided staff with guidance on how to meet people's needs.

Comments we received included 'there are always loving people around you', 'some of the carers are very caring and very good, sometimes they can have an off day, just like me and you' and 'it is like a family here'.

Is the service responsive?

People where possible were involved in making decisions about their care. People were supported to attend activities within the service and in the community.

Relatives told us they were always kept up to date with the condition of their family member. People were enabled to maintain relationships with their friends and relatives.

Is the service well-led?

The provider and manager actively sought the views of people and their representatives so that areas for improvements could be identified and addressed.

All the staff we spoke with said they were supported to carry out their role and were provided with support and training. They told us they were able to raise any concerns they had with the manager and provider.

The provider had in place systems to monitor the quality of the service and where shortfalls were identified action plans with timescales were drawn up to address them.

The staff conveyed a knowledge and understanding of each person's needs and how they liked to be supported. We saw the people who use the service and the staff had developed positive relationships with each other and there was good communication and a relaxed atmosphere within the home.

However, we identified that there were inadequate systems in place regarding consent and assessing people's capacity to make decisions about their lives. This meant that the legal requirements relating to the obtaining of consent were not followed, which put people at risk of receiving or omission of treatment without their consent.

We also noted some shortfalls in relation to infection control and access to protective equipment, which could put people at risk from the spread of infection.

The staffing levels did not meet the needs of the people who use the service, and could put people at risk of inappropriate care. Similarly, the arrangements for the induction of new staff to the service were inadequate and put people at risk of being supported by staff who did not know their needs or how to support them appropriately.

One relative commented that the health and well being of their family member had noticeably improved during their stay at Neem Tree Care Centre. A comment was made that staff are 'warm and caring'. One relative had raised a concern with the home about the care of their family member and this was being investigated.

Policies and procedures were in place for staff guidance on recognising and reporting abuse.

Induction training and mandatory training was in place for staff. All staff had received formal supervision with a manager. Staff annual appraisals had not been completed.

There was a system in place for obtaining the views of people who use the service and their relatives. Regular audits were carried out on the quality and safety of care.