Archived: Treelands Care Home

Treelands Care Home is registered to provide accommodation and nursing care for up to 80 people. Accommodation is provided over 2 floors and within 4 units: Sycamore provides care and support to people requiring residential care; Beech provides care and support for people with complex needs, such as mental health needs; Oak provides general nursing care and Elm provides care and support for people living with dementia. At the time of our inspection, Elm unit was closed for refurbishment with the majority of people from this unit being supported on Oak. There were 54 people living at the home at the time of our inspection.

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

Improvements were required with medicines management, record keeping, staff training and supervision, engagement with people and relatives, reporting of incidents to CQC and the audit and governance process. Issues noted at the previous inspection had not been addressed. The new home manager was open and honest about the challenges they faced and where improvements were needed.

People told us they felt safe living at the home. Staff had completed safeguarding training and knew how to report concerns. People, relatives and staff provided mixed comments about staffing levels. We were told staffing was sufficient to meet needs and keep people safe, but care was task orientated, with limited time for staff to engage in conversations, activities or spend quality time with people. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Accidents, incidents and falls had been documented but reviews to look for trends and help prevent reoccurrences had not taken place. We found the home to be clean, with effective cleaning and infection control processes in place.

Due to the short time they had been in post, some people and relatives we spoke with were unsure who the current manager was. Staff spoke positively about the current management team, which included the home manager and an interim clinical lead provided via a consultancy firm, who they felt had started to make necessary changes and improvements in the home. Despite a lack of engagement through meetings and surveys, people and relatives told us they would recommend the home to others, as they had no concerns with the care being provided.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 04 May 2022). The service remains requires improvement.

Why we inspected

We received concerns in relation to people not receiving safe care, safeguarding concerns not being reported correctly, staffing levels not being appropriate, post fall observations not being completed, the audit and governance process not being followed and action plans not being followed through.

As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

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 Treelands Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to the management of medicines and the audit and governance process at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Treelands Care Home is registered to provide accommodation and nursing care for up to 80 people. Accommodation is provided over two floors and is divided into four units: Sycamore provides care and support to people requiring residential care; Beech provides care and support for people with complex needs, such as mental health needs; Oak provides general nursing care and Elm unit provides care and support for people living with dementia. At the time of our inspection there were 60 people living at the home.

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

We found improvements were required with the management of medicines and the audit and governance process. People’s medicines were not always managed safely and auditing had not been completed consistently. Actions, outcomes and lessons learned had not always been generated and used to help drive improvements.

People told us they felt safe living at Treelands Care Home. Staff had received training in safeguarding and knew how to identify and report concerns. Staffing levels were allocated based on people’s needs, with people reporting no concerns with waiting times when they needed support. The necessary employment checks had been completed, to ensure staff were suitable to work with vulnerable people. Accidents, incidents and falls had been documented consistently, although further work on looking for patterns and trends to prevent reoccurrence was required.

Work was needed to ensure staff training and supervision was up to date, however, this had been identified by the provider with an action plan in place. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. The provider had identified deprivation of liberty safeguard applications had not been submitted or renewed timely and had taken action to ensure this was addressed. People’s healthcare needs were being met. Referrals had been made timely to professionals when any issues had been noted or concerns raised. Equipment was in place to support people to stay well. People provided mixed feedback about the quality of the food provided, however, the mealtime experience was positive with people receiving a choice of meal and support with eating and drinking as required.

People and relatives spoke positively about the staff and the care and support provided. People told us they were treated with dignity and respect and offered choice. One person told us, “The staff are very good, more like family or friends than staff, we have a laugh and some good banter.”

Care files contained personalised information about each person and how they wished to be supported and cared for. Observations showed staff knew people well and provided care and support in line with people’s wishes. Peoples’ social and recreational needs were met through an activities programme, facilitated by an activity co-ordinator and staff members. The provider had identified further work was needed to ensure people cared for in bed, received enough activity and stimulation. People and relatives knew how to complain, but none of those we spoke with had needed to.

The provider had introduced a continuous improvement plan, to address issues they had identified. This included actions around audit completion, record keeping and meeting completion. The home did not currently have a registered manager in post. People and staff commented on the current management situation impacting on consistency. One person told us, “I can talk to the management and they are approachable, but there has been lots of changes which is unsettling, I prefer continuity.” A new manager was due to commence post on 19 April 2022.

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 re-registered with us on 10 September 2020 and this is the first inspection. The last rating for this service under the previous provider was good (published May 2018).

Why we inspected

This was a planned inspection based on the date of registration in order to provide a rating for the service.

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.

You can read the report from the comprehensive inspection of the previous provided, published May 2018, by selecting the ‘all reports’ link for Handsale Limited - Treelands Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to medicines management and the audit and governance process.

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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.