Tall Trees

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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. This is the first assessment for this service, due to a change in registration. This key question has been rated good This This meant people were protected from avoidable harm.

This service scored 63 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. A system was in place for monitoring incidents with an in-depth trends analysis completed and escalated to the provider. The registered manager had oversight of all accidents, incidents and events within the service.

Whilst the provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored, we received some feedback from healthcare professionals raising concerns about continuity of care and staff not always consistently following guidance and recommendations to meet people’s health needs. One healthcare professional told us, “We receive conflicting information from staff members re aspect of patient care.”

The provider did not always work with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. We received feedback from healthcare professionals that safeguarding concerns were not always raised in a timely manner where there were concerns about people’s safety. We were told of recurring themes of a limited understanding of safeguarding procedures and a failure by the management team to seek advice following incidents that occurred at the service.

Despite these concerns, relatives told us their relative was safe living at Tall Trees. One relative told us, “[Family member] is safe. They have had falls and bumps; staff tell me immediately and how it happened. [Family member] is now in the communal areas more, they walk about but the staff are aware of where they are.” During our visit we observed staff supporting people with dignity and respect.

Staff had access to the provider’s safeguarding policy and had received safeguarding training. Staff demonstrated they understood their role and responsibilities in keeping people safe from abuse and avoidable harm. A staff member said,“I would report it to the senior staff while on duty and if proper action is not taken, I would inform the management and if not satisfied, I will report to the social worker involved with the individual, also to the Essex safeguarding team, the police.”

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. We observed staff following safe practices. They were attentive and responsive to people’s individual needs. People told us they felt comfortable and secure living at the service and were involved in managing their care risks where possible. One person said about the staff, “They are caring, I use the buzzer, and they come quick, I am alright.” Another person told us, “I feel very safe, the security is good, people cannot walk in. I feel safe knowing help is there if I need it.”

Risk assessments for people were consistently reviewed and updated in a timely manner. There was guidance written for staff about how to manage risks that had been identified, however, further clarity was needed to ensure plans of care were in line with peoples identified needs. For example, 1 person’s care plan stated they needed the assistance of 1 staff for personal care in one section of their care plan, but 2 staff in another. For another person a specific incident had not been considered in their risk assessment. The registered manager took immediate action to address any anomalies identified.

We reviewed care planning documents and saw recognised tools such as a pressure ulcer risk assessment and nutrition screening tool were used. These helped assess the level of risk for people. Where people had risks associated with their care, the required equipment had been identified. Examples included a pressure mattress to help reduce the risk of a pressure ulcer developing. We saw and records confirmed that the equipment was used as planned to help mitigate against any risks.

Fire safety procedures were in place to protect people from the risk of fire. These included regular checks of the fire alarm system. Fire exits were clear at the time of our visit. Staff had received training in fire safety and evacuation. Everyone living at the home had a personal evacuation escape plan (PEEP). PEEPs explain how each person would be evacuated from the building in the event of an emergency.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. However, the building was ‘tired’ in places and not to a consistently high standard. For example, carpets were stained and there was a lot of damage to woodwork and paint on the walls. The provider told us they had already invested in some improvements but were aware of the improvements still needed and were considering their refurbishment options.

The provider had systems and processes in place to manage the safety of the service, and a range of health and safety checks were undertaken incorporating electrical, gas and water safety.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Half of the care staff we spoke with told us they felt staffing levels were not sufficient to meet people's needs and described how they were so busy they were stretched and had insufficient time to spend with people. One staff member said, “Overall, current staffing levels do not allow us to meet [people’s] needs in a timely or safe way, and this poses a risk to their well-being and dignity.” Another staff member told us, “I don’t think we have enough staff to meet residents demands in a timely manner.” The positive feedback we received from staff included, “Tall Trees care home normally has a good staffing ratio, and the on-call managers are most of the time very prompt to cover any sickness.” and “Most of the time, staffing levels are sufficient. When it’s busy, the team supports each other to make sure everyone’s needs are met.”

We received mixed feedback from people’s relatives about the staffing levels. Some were positive that there were sufficient staff to meet their needs, although several referred to a high turnover of staff which had led to some loss of continuity. Relatives recognised that care staff worked hard and were busy, but some commented that this didn’t impact on their opportunities to spend quality time with people. One relative told us, “Tall Trees over this year have suffered a high turnover of staff and many of the excellent experienced staff have left. This naturally has had a significant impact on the work levels. New staff are being recruited all the time, which is good, but it takes time to train them up and this puts extra pressure on those experienced staff who have remained. Another relative said, “They have had a staffing problem over the last couple of months, lots left and new faces but the last 2 weeks I have felt more confident that things are better and [family member] is safe.”

We spoke at depth with the registered manager about the staffing levels. The registered manager told us the staffing levels were based on people’ dependencies and that observations[CK1][NL2] of care in practice are also used to determine the staffing levels.

During our visit, we observed that there were enough staff on shift to spend time with people at frequent episodes during the day. Staff were visible and were quick to intervene if people became upset or distressed, showing concern and giving people adequate time. Staff were not task orientated and were available and interacting with people.

The provider had appropriate recruitment procedures in place, which ensured staff were suitable to support people who lived at the home. Disclosure and Barring Service (DBS) checks had been undertaken. A DBS check is a criminal record check on a potential employee's background. The provider checked potential staff's previous employment history, their identity and obtained references about them.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading. We found that processes to ensure people’s mattresses were being regularly and effectively cleaned were not in place. This meant there was risk of people sleeping on a soiled mattress.

There was an infection, prevention and control (IPC) policy in place and the management team were clear on the IPC procedures required and their responsibility to provide Personal Protective Equipment (PPE) for staff. There was a sufficient supply of personal protective equipment (PPE) available at the service. Staff were observed using PPE appropriately, in line with infection control guidance. There were systems and processes to reduce clinical infection risks with regular clinical review meetings held.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. One relative told us, “This is now controlled much better and the nurse who gives [family member] their medication ensures they have been swallowed before leaving them. It is true [family member] can be very difficult at times in taking their medication but I am happy with the controls now in place. The staff now also appreciate the importance of the drugs having to be administered within a given time frame.”

Staff were trained to safely administer people’s medicines and their competency to do this was regularly checked. The management team audited and had checks in place to make sure medicines were being administered safely.

Medicines administration records were accurate and complete. The service followed guidance for the receipt, storage, administration, and disposal of medicines. People received their medicines as prescribed. We observed nursing staff administering people’s medicines and found they were attentive to people’s needs and offered support and personalised care when administering medicines.