Treetops Court Care Home Also known as 1-2655136637

Treetops Court Care Home is a nursing residential care home providing nursing and personal care to up to 70 people. The service provides support to people over the age of 65 who have dementia, mental health needs, physical disabilities. At the time of our inspection there were 47 people using the service.

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

The provider ensured annual safety checks being completed but on-going checks and building maintenance checks were not being completed consistently. This meant people were at higher risk if faults were not being identified and rectified quickly.

Medicines quality audits were not robust enough to effectively identify errors and were not being carried out consistently. However, no one had come to harm.

People were not supported to have maximum choice and control of their lives and did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Staff were safely recruited and trained, but not all staff had all relevant training to support the needs of all people in the home.

Most people told us they felt safe, relatives’ views on the service were mixed.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

The last rating for this service was requires improvement (published 30 October 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last five consecutive inspections.

Why we inspected

We carried out an unannounced inspection of this service on 14 and 16 June 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe, effective and well led.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has not changed following this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Treetops Court Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the overall governance of the service at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Treetops Court Care Home is a residential care home providing personal and nursing care for up to 70 people aged 65 and over. At the time of the inspection Treetops Court Care Home accommodated 63 people. There are three separate units accommodating people with differing needs. Some of the people living in the home are living with dementia, mental and physical disabilities.

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

People were at risk of cross infection because staff were not consistently following guidance to ensure people were protected from the risk of harm. People’s assessed risks were not always mitigated, and medicines were not consistently managed in a safe way.

Improvements were needed to ensure staff were deployed effectively across the service and to ensure all records contained an accurate reflection of people’s needs.

The manager and provider had started to implement new systems to make improvements to the monitoring of the service. However, these still needed to be fully imbedded and sustained.

People were safeguarded from the risk of suspected abuse and the provider had learnt lessons when things went wrong.

People and staff felt able to approach the manager, who promoted a culture of openness and transparency within the service. The manager worked alongside professionals to ensure people’s health and wellbeing were maintained.

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

Rating at last inspection

The last rating for this service was requires improvement (published 30 May 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

We received concerns in relation to infection control, staffing and safeguarding people from abuse. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The overall rating for the service has remained the same as Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Treetops Court Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified a breach of Regulations in relation to the safe care and treatment of people. Improvements were needed to infection prevention and control, medicines and mitigating people’s risks.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Treetops Court Care Home is a nursing home that was providing nursing and personal care to 66 people at the time of the inspection but was registered for up to 70 people. People may have had support needs in relation to their dementia or mental health. There were older and younger people using the service and some may have had a physical disability.

People’s experience of using this service:

Systems were not always effective at identifying areas for improvement although there had been many improvements since the last inspection. Documentation in relation to people’s mental capacity was not always personalised; action was taken immediately following our feedback.

Nationally-recognised best practice assessments were used to help monitor people’s health, although these had not always been effective. People were supported to access other health professionals.

Staff were recruited safely and there were enough staff to support people. Staff received training to be effective in their role and felt supported.

People had their risks assessed and planned for. People received their prescribed medicines and measures were put in place following our feedback about improvements that could be made.

People were protected as staff understood their safeguarding responsibilities and followed infection control procedures.

Lessons had been learned when things had gone wrong.

People were supported to have food appropriate to their needs. People enjoyed the food and had a choice.

The building was suitable for the needs of people and further improvements were planned.

People were treated with dignity and respect. People were involved in decisions about their care and supported to be as independent as possible.

People received personalised care that met their needs. Activities were available for people to partake in. People and relatives knew how to complain and felt able to; action was taken following a complaint.

People were supported at the end of their life and further work was planned to ensure plans contained sufficient personalised detail.

Relatives and staff all felt the service had improved since the last inspection. They felt positively about the registered manager and felt they could contribute to the running of the service.

The provider was proactive in supporting the service and they worked in partnership with other organisations and professionals.

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

Rating at last inspection:

At the last inspection the service was rated Requires Improvement (report published 20 October 2017).

Why we inspected:

This was a routine inspection planned on the previous rating.

Follow up:

We will continue to monitor the service and check improvements have been made at our next inspection.

There was a Registered Manager 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. However, after our inspection the manager left so there was no longer a registered manager at the service.

At this inspection we identified continued 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 the full version of the report.

People were not always protected from harm because we found incidents of alleged abuse had not always been reported to the local safeguarding authority.

Training was not always effective as safeguarding incidents had not been recognised, and we observed some examples of poor moving and handling. Records confirmed training was not up to date for all staff, and staff were not always recruited safely

Systems were in place to monitor the quality of the service; however these were not always effective. Although there were regular checks carried out by the registered manager, it was not always clear what documentation had been viewed. Incidents had not been identified, such as safeguarding incidents between people who lived at the service.

Staff were not always deployed effectively, people and relatives told us they sometimes had to wait for support and we saw that communal areas were sometimes left unattended.

Plans were not always in place to support people during periods of agitation. Staff did not always have guidance to follow in relation to people’s choking risks.

We observed some poor examples of moving and handling and clear guidance was not always available for staff. The administration of medicines was inconsistent, with some being given correctly and some not in line with guidance.

Not all of the principles of the Mental Capacity Act 2005 were being followed. Best Interest Decisions were not person specific. However, mental capacity assessments were being carried out and Deprivations of Liberty Safeguarding applications were made.

There was sometimes a delay in seeking support from other health professionals for some people to maintain their health and wellbeing. However some people were receiving timely support.

Care plans sometimes lacked detail and there was not always life history information available.

There was mixed feedback about the activities available for people to partake in, with some people thinking there was not enough to do whereas other’s enjoyed what was on offer.

The service could not always be caring as staff were not always deployed effectively. However, staff were kind and people’s privacy and dignity was respected and we saw staff offering people choices.

People told us they felt able to complain and we saw that complaints were responded to appropriately.

People were offered a choice of meals and told us they liked the food.

People told us they felt the registered manager was proactive and supportive, however the registered manager is no longer working at the home. The provider has told us a new manager would be starting. Staff told us they had supervisions and felt supported in their role. Notifications had been submitted about incidents which the registered manager had been aware of, which is a requirement.

Building checks were undertaken to ensure the environment was safe.

There was a Registered Manager 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 identified 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 the full version of the report.

People were not always protected from harm because we found incidents of alleged abuse had not always been reported to the local safeguarding authority.

We found there were some gaps in the Medication Administration Records (MAR), so it was not clear whether people had received their medicine as prescribed.

Staff did not always have the effective training they required to assist someone who had challenging behaviour and this had left both people and staff at risk.

Risk assessments were in place to support people and staff however they had not always been followed or updated following a person’s needs changing.

Systems were in place to monitor the quality of the service; however these were not always effective. Although there were regular checks carried out by the registered manager, it was not always clear what documentation had been viewed. Incidents had not been identified, such as safeguarding incidents between people who lived at the service, the number of episodes of challenging behaviour some people were experiencing and staff needing to intervene and omissions in the medicines documentation.

There were limited activities available for people to partake in, with some people thinking there was not enough to do.

Accidents were documented and action taken and they were analysed for trends in order to prevent and reduce future occurrences and action had been taken after each accident.

Staffing levels were sufficient to meet people’s needs and staff had the appropriate checks in place to ensure they were safe to work with vulnerable people. Staff had the appropriate training to care for the people who lived in the home.

The principles of the Mental Capacity Act (MCA) 2005 were upheld and people’s consent was gained and appropriate people were consulted if someone lacked capacity. There were Mental Capacity Assessments in place and appropriate Deprivation of Liberty Safeguards (DoLS) application had been made.

People were offered a choice of meals and people told us they liked the food.

People had access to healthcare services and referrals were made when necessary to other professionals for their input.

Staff were caring and people’s privacy and dignity was respected. The registered manager and the staff knew people who lived in the home very well. People had things explained to them to offer reassurance and so they could make a decision, such as when they were being hoisted the staff clearly explained each step of their support.

People, relatives or representatives had been involved in the planning and review of their care and treatment.

There was regular opportunity for people, relatives and staff to feedback about the care, through a variety of different formats such as surveys, comment cards and in conversations with the registered manager. People also knew how to complain and were confident it would be dealt with if something was raised.

People told us they felt the registered manager was approachable and supportive. It was also evident that action had been taken if an issue was identified.