CQC report explained · a residential care home
What the CQC found at Pine Trees Care Centre
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found effective safeguarding, risk management, staffing, medicines and infection control arrangements. An electronic system identified one missed medicine administration during the inspection, which was investigated and addressed promptly without negative impact.
- Effective?
- Good
- People’s needs were assessed before admission. Staff were trained and supported, people received suitable food and drinks, and staff worked with health professionals to manage people’s health.
- Caring?
- Good
- This question was not inspected during this focused visit. The previous rating was used in calculating the overall rating.
- Responsive?
- Good
- This question was not inspected during this focused visit. The previous rating was used in calculating the overall rating.
- Well-led?
- Good
- Inspectors found approachable management, regular communication, effective audits and a culture focused on people’s needs. The home acted on feedback and worked with health and social care professionals.
What inspectors found, May 2022
Rated Good; inspectors found safe, effective and well-led care, with no evidence that the reported management concerns had put people at risk.
This was an announced, focused inspection on 23 April 2022. One inspector spoke with eight people, 12 staff and reviewed care, medicine, recruitment and management records. Feedback was also sought from relatives, the local authority and health professionals.
The home was rated Good for Safe, Effective and Well-led. Inspectors found suitable safeguarding systems, managed risks, enough staff, safe medicines processes and effective infection control. Staff were trained and supported, and people received help with food, drinks, healthcare and decision-making.
The inspection followed anonymous concerns about management and leadership. A new manager had been appointed since the previous inspection, and people, relatives and staff spoke positively about the management team. Inspectors found no evidence that people were at risk of harm from the concerns.
The overall rating remains Good, the same as at the previous inspection in October 2019. Caring and Responsive were not inspected, so their previous ratings were carried forward when calculating the overall rating.
Clear risk planning
People’s risks were assessed and staff had guidance to follow. Inspectors found that risks were regularly reviewed and managed.
“Risks to people's safety and wellbeing were assessed and well managed.” from the report
Staffing and training
Inspectors found enough staff to meet people’s assessed needs. Staff had relevant training, induction and ongoing support.
“There were sufficient numbers of staff employed and on duty to meet people's assessed needs.” from the report
Good health support
Staff monitored areas such as weight, nutrition, hydration and falls. They made timely referrals when people’s health needs changed.
“Staff were proactive in making timely referrals to health professionals when they had concerns around people's health and well-being.” from the report
Strong management oversight
The management team used audits, meetings and feedback to monitor the service and make improvements. People, relatives and staff described managers as approachable.
“There were robust quality assurance and auditing systems in place designed to drive improvements in the service's performance.” from the report
One medicine administration alert
minorThe electronic medicine system identified that one medicine had not been administered during the inspection. Staff investigated and corrected the issue promptly, and inspectors found no negative impact for the person.
“This occurred during the inspection. This was investigated immediately, and the issue addressed promptly so that there was no negative impact for the person involved.” from the report
- 01What checks are now used to make sure every medicine is administered and recorded correctly?
- 02How do you maintain staffing levels when there is sickness or disruption linked to COVID-19?
- 03How often is staff training refreshed, and how do you check that staff remain competent to meet my relative’s needs?
- 04What progress has been made with the formal quality assurance process and gathering views from relatives and residents?
- 05What testing and protective equipment arrangements apply when families visit?
This was a focused inspection of Safe, Effective and Well-led only; Caring and Responsive were not inspected and their previous ratings were carried forward. This explanation was written from the published report of 11 May 2022 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, October 2019
Rated Good; inspectors found kind, safe and responsive care, with clear improvements since the previous inspection.
This was an unannounced inspection on 16 and 17 September 2019. Inspectors spoke with people living in the home, relatives and staff. They also observed care and checked care plans, medicine records, staff files and management records.
All five areas were rated Good: Safe, Effective, Caring, Responsive and Well-led. Inspectors found suitable safeguarding, risk assessment, staffing and medicine systems. They found people were treated with kindness, involved in daily choices and supported to take part in activities.
There were some small shortfalls. One bedrail cover was missing during the visit, and some pressure-relieving items were not properly covered. Some people also said they had not been involved in care planning, or could not remember being involved.
The previous rating was Requires Improvement, with multiple breaches of regulation. The home had completed an action plan, and inspectors found enough improvement for the breaches to be removed. The manager was not yet registered with CQC, but an application had been submitted.
Medicines were organised
The medicines system was organised and staff were trained before giving medicines. Inspectors saw respectful support when people took them.
“The medicines system was well organised and staff received suitable training.” from the report
Kind and respectful care
People and relatives gave positive feedback about staff. Inspectors observed staff asking permission and supporting people in a kind and friendly way.
“We observed positive interactions between staff and people who used the service.” from the report
Activities and community links
People could join group or one-to-one activities, go on outings and maintain links with local religious and community groups.
“People had the opportunity to participate in activities and to spend time with the wider community.” from the report
Improvement since the last inspection
The home had acted on the previous inspection findings. The provider was no longer in breach of the regulations identified previously.
“At this inspection we found improvements had been made and the provider was no longer in breach of regulations.” from the report
Bedrail cover was missing
seriousOne person's bedrail was uncovered during the inspection. Inspectors said this created a risk of injury, although the cover was refitted that day and more covers were ordered.
“One person's bedrail was not covered. This created a risk of injury against bedrails when a person was in bed.” from the report
Some equipment was not properly covered
needs fixingSome mattresses and pressure-relieving items were difficult to clean and dry because their covers were not suitable. A replacement cushion and an additional mattress cover were arranged during the inspection.
“Although on the whole suitable measures were taken to minimise the risk of infection some mattresses and other pressure relieving items was not appropriately covered.” from the report
Possible lower staffing at some times
needs fixingPeople generally said staffing was enough, but some comments suggested there were fewer staff in the evenings and at weekends.
“Although we did receive comments there appeared less staff in the evenings and at weekends.” from the report
Care planning involvement was uneven
minorSome people and representatives said they had not been involved in care planning or could not remember being involved. The manager said people were included where possible.
“However, some people said they had not been involved in the process or could not remember.” from the report
- 01How do you make sure every bedrail has the correct cover in place, including when covers are being washed?
- 02What action has been taken to ensure mattresses and pressure-relieving equipment can be cleaned and dried properly?
- 03How do you maintain safe staffing levels in the evenings and at weekends?
- 04How will my relative and our family be involved in writing and reviewing the care plan?
- 05Has the manager's application to register with CQC been completed?
This unannounced planned inspection looked at all five CQC questions, including the care provided and the home itself, and followed an earlier Requires Improvement rating. This explanation was written from the published report of 17 October 2019 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.
Every inspection of Pine Trees Care Centre
9 rated inspections over 6 years: the service has held its Good rating throughout.
- May 2022Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2019Goodup from Requires improvementSafe: GoodEffective: GoodWell-led: Good
- May 2019Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Inadequate
- November 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- April 2018Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- December 2017Inadequatedown from Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- June 2017Requires improvementstayed Requires improvementSafe: Inadequate
- June 2017Requires improvementdown from GoodSafe: InadequateEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- May 2016GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- September 2014
Report published without a new overall rating.
- July 2014
Report published without a new overall rating.
- October 2013
Report published without a new overall rating.
- June 2013
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- February 2012
Report published without a new overall rating.
- September 2011
Report published without a new overall rating.
- June 2011
Report published without a new overall rating.
- February 2011
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 9 December 2010.
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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