Pear Tree Court

Pear Tree Court is a residential care home providing personal and nursing care to 46 people at the time of the inspection. The service can support up to 72 people. The service was purpose built and accommodation in en-suite bedrooms is arranged over three units on different floors. Gale unit provides residential care, Napier unit provides care and support for people living with dementia and Murray unit provides nursing care. Each floor has its own lounge, dining room and TV lounge. Other facilities include a café, hair salon and cinema.

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

Risks to people were not always assessed or managed safely and records relating to risk management were not always accurate or consistent. Actions were being taken to improve risk management, however the provider needs to check these are effective.

The management of people’s medicines was not always safe. We did not find any harm to people, but improvements were required in the management of controlled drugs, medicine storage, topical medicines (applied to the skin) and decision making.

We received mixed feedback about staffing levels from staff, relatives and people. The provider used a dependency tool to calculate how many staff were required to meet people’s needs and this showed enough staff were available. The provider had acted on concerns about staff deployment to use staff resources more effectively.

The manager and staff understood their responsibilities to keep people safe. Incidents including safeguarding were reviewed to ensure appropriate action were taken. The provider was acting to make improvements to the safety of care people received following concerns identified by the local authority safeguarding team.

Quality assurance systems had not always been effective in identifying the concerns we found at this inspection and bringing about improvement. We observed staff did not always treat people with dignity and respect, the manager acted on this immediately. There had been difficulties in establishing a positive culture in the staff team, we have made a recommendation about this. We received positive feedback about the new manager.

There was a limited approach to obtaining the views of staff, relatives and people who use services to show how they are involved in shaping the service. The provider told us this was because their priority had been to embed government guidance about safe working practices in relation to COVID-19. The service had received compliments and a high score on a care home review website for the care provided.

Rating at last inspection

The last rating for this service was Good (published 2 May 2019).

Why we inspected

The inspection was prompted in part due to concerns received about neglectful care and treatment, how people were protected from the risk of harm and abuse and a lack of leadership. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led only. Ratings from previous comprehensive inspections for those key questions not inspected 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.

We have found evidence that the provider needs to make improvements. The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Pear Tree Court 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.

We have identified breaches in relation to safe care and treatment and governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

Pear Tree Court is a residential and nursing care home that was providing care and support to 40 people at the time of the inspection. The home supported people living with dementia and with physical care needs.

People’s experience of using this service:

• People and their relatives told us they were ‘happy’ with the service. A person said, “I’m lucky to live in such a nice place” and relatives described the service as “Very good”, “Excellent” and “Well-run.”

• We had received some feedback of concern prior to our inspection about staffing levels in the home. We found that people were safely cared for but staff supporting people with more complex needs were stretched at times which meant people’s needs were not always met at their preferred times. This could also impact on people’s opportunities to participate in activities when they required the support of staff to do so. We saw the provider was acting to improve this, and staff people and their relatives told us improvements had recently been made. Further activity staff had been recruited and the provider was acting on their plan to improve the deployment and supervision of staff across the home to ensure sufficient staffing to more effectively meet people’s needs.

• People spoke positively about the staff and leadership in the home. We found improvements were required in the training and supervision of staff to ensure training was up to date and completed by all relevant staff and all staff received regular supervision. We have made a recommendation about staff training and supervision.

• The home was purpose built and maintained to a high standard. People and their relatives told us how they enjoyed the facilities available in the home. A person’s relative said, “It’s so clean here, it doesn’t feel like a nursing home, more like a hotel.” People living with dementia benefited from a ‘dementia friendly’ environment which promoted their wellbeing.

• People received care and support based on an assessment of their needs including any areas of risk. People’s healthcare needs were met, by on-site nursing staff and community health care professionals as required. Person centred care plans were in place to guide staff on people’s needs and preferences and people told us they received the care they needed.

• A process was in place to assess people’s mental capacity and where people lacked mental capacity, decisions were usually made in their best interests, with some exceptions. We have made a recommendation about the application of the Mental Capacity Act (2005).

Rating at last inspection: This was the first inspection of this service which was registered on 1 February 2018.

Why we inspected: This was a planned inspection in line with CQC’s inspection methodology.

Follow up:

• There is no required follow up to this inspection however we will continue to monitor the service through information we receive. We will follow up on the recommendations made in this report at the next inspection.

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