CQC report explained · a nursing home
What the CQC found at Green Tree Court
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Requires improvement
- Inspectors found medicines practice that did not always follow the home's policy. They also found an inaccurate or conflicting risk record, although other safety systems, staffing and infection control were good.
- Effective?
- Outstanding
- People had a high-quality environment, good food choices and specialist support. Staff had training and skills suited to people's individual and complex needs.
- Caring?
- Good
- Staff were often kind, compassionate and supportive. However, inspectors saw some communication and actions that did not fully support people's dignity or enjoyment.
- Responsive?
- Outstanding
- Care was personalised and adapted to people's needs, wishes and communication methods. People were supported with activities, community links and their individual goals.
- Well-led?
- Good
- There was an established management team, clear responsibilities and regular quality checks. Managers acted quickly when inspectors raised issues.
What inspectors found, February 2020
Rated Good overall; inspectors found outstanding effective and responsive care, but safe care required improvement because of medicines concerns.
This was an unannounced inspection over two days. Inspectors spoke with people, relatives and staff, observed care and meetings, and checked care records, medicines, recruitment files, audits and risk records.
The home was rated Good overall. Effective and Responsive were rated Outstanding. Caring and Well-led were rated Good. Safe was rated Requires Improvement, which means some aspects were not always safe and there was limited assurance about safety.
Inspectors found concerns with medicines practice. This included staff not following the medicines policy, one person's prescribed thickener being used for another person, and some medicines not being clearly checked for effectiveness. No one was harmed, and managers took immediate action.
Inspectors also found some communication that could reduce people's dignity or enjoyment. Alongside this, they saw caring staff, strong staffing levels, very good support for people's individual needs, and a well-designed environment.
Staffing and availability
Inspectors found high staffing levels, with staff available to support care needs and time to spend with people.
“Rotas evidenced high levels of staffing to ensure people had access to the care that met their needs and protected them from risks.” from the report
Personalised support
Care was adapted to people's wishes, abilities and communication needs. Inspectors saw examples of support improving people's confidence, mobility and enjoyment of life.
“People received care and support in a way that was responsive to their needs.” from the report
Dementia-friendly environment
The environment was designed to help people living with dementia feel calm, orientated and able to move around freely.
“The dementia unit was calm and had a happy and uplifting atmosphere.” from the report
Training and specialist care
Staff received induction, ongoing training and bespoke training for complex needs. The home also worked with specialist health teams.
“Bespoke training was used to ensure staff had specialist skills and knowledge to work with people with complex needs.” from the report
Medicines practice
seriousSome medicines were handled in ways that did not follow the home's own policy. A prescribed thickener belonging to one person was also used for another person's drink.
“We saw registered nursing staff carrying out a practice, which was not in accordance with the service's own medicines policy.” from the report
Checking treatment effectiveness
needs fixingSome records did not show whether treatment was working, including whether prescribed pain relief had reduced a person's pain.
“The service's systems did not always include an assessment of the effectiveness of treatment, including pain relief people had been given.” from the report
Accuracy of risk records
needs fixingOne care record contained conflicting or incorrect information about a person's skin and pressure ulcer risk. Inspectors discussed this with nursing staff.
“However, one plan contained conflicting or incorrect information.” from the report
Respectful communication
needs fixingInspectors saw staff speaking behind people's backs and saw communication or actions that interrupted people's enjoyment and independence. Managers said they would take immediate action.
“We saw examples where staff spoke with each other behind people's backs, which in one instance interrupted one person's enjoyment of an activity.” from the report
- 01What changes have been made to ensure all medicines are administered in line with the medicines policy?
- 02How do you make sure prescribed thickening agents and other treatments are used only for the correct person?
- 03How do you now record and review whether medicines, including pain relief, are effective?
- 04How are care plans checked so that risk information is accurate and up to date?
- 05What action has been taken to ensure staff communicate respectfully around people and during meals and activities?
This was an unannounced inspection covering all five key questions, the premises and the care provided; inspectors also reviewed records, medicines, staffing, risk management and quality checks. This explanation was written from the published report of 26 February 2020 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, February 2017
Overall Outstanding; inspectors found kind, personalised care and strong leadership, with safety rated Good.
The inspection was unannounced and took place on 12 December 2016. One inspector spent time with people living in the home, relatives, staff and health professionals. They observed care and checked care records, medicines, staff files, training, equipment and quality checks.
People were described as safe and well supported. Staff knew people's needs, risks and preferences. Medicines were given when needed. Staffing levels were high, and staff supported people to remain independent where possible.
Inspectors found outstanding care in four areas: effective, caring, responsive and well-led. Staff were well trained, kind and respectful. People had personalised activities, flexible meals and good access to health professionals. This was the home's first inspection since registration, so there was no earlier rating to compare.
Kind and compassionate staff
Staff were consistently caring and often gave people extra time and support. Inspectors saw relationships that helped improve people's quality of life.
“People were supported by very kind, caring and compassionate staff who often went the extra mile to provide people with good, high quality care.” from the report
Personalised care
Staff built care around people's histories, preferences, goals and routines. This helped people take part in activities and regain confidence or independence.
“People had access to and were involved in developing personalised activities that complemented their individual hobbies and interests.” from the report
Skilled and effective support
Staff training was put into practice, including support for dementia, nutrition, mobility and individual health conditions. Inspectors found examples of people's health and wellbeing improving.
“People received effective care based on best practice from staff who had the knowledge and skills required to enable them to carry out their roles.” from the report
Respect and choice
People were involved in decisions about their care and daily routines. Staff respected privacy, used preferred names and supported people to remain as independent as possible.
“People were actively encouraged to make choices about how they lived their lives and the focus was on promoting independence and wellbeing.” from the report
Open leadership
Managers and staff were visible, approachable and willing to act on feedback. Inspectors found a shared focus on improving people's care.
“There was an open, inclusive culture within the home where people, relatives/friends and staff were listened to and felt that they mattered.” from the report
Inspectors raised no specific concerns in this report.
- 01How will you keep staffing levels under review as more people move into the home?
- 02How will you support my relative's independence while managing their specific risks, such as falls or poor eating and drinking?
- 03How are medicines reviewed, especially medicines given only when needed or disguised in food or drink?
- 04How will you support my relative's particular diet, swallowing needs and food preferences?
- 05How will you involve our family in care planning, activities and decisions if my relative cannot make some decisions themselves?
This was an unannounced first inspection covering all five CQC questions, using observations, discussions and checks of care, medicines, staffing, premises and quality records. This explanation was written from the published report of 17 February 2017 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk. The report was longer than we could read in one go; the later sections may not be reflected.
Every inspection of Green Tree Court
2 rated inspections over 3 years: the service has slipped, from Outstanding to Good.
- February 2020Goodcurrent ratingdown from OutstandingSafe: Requires improvementEffective: OutstandingCaring: GoodResponsive: OutstandingWell-led: Good
- February 2017OutstandingSafe: GoodEffective: OutstandingCaring: OutstandingResponsive: OutstandingWell-led: Outstanding
- November 2014
Registered with the Care Quality Commission on 14 November 2014.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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17 live-in carers within about an hour of Devon
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £1,020 to £1,270 a week. 15 can care for a couple. 13 years' experience on average.
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Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.