CQC report explained · a nursing home
What the CQC found at Shaftesbury Treetops
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found systems to assess risks, prevent infection, manage medicines and learn from incidents. Guidance for managing hypoglycaemia could have been clearer, and the manager agreed to address this.
- Effective?
- Good
- Staff had appropriate induction, training and supervision. People received support with nutrition, healthcare, rehabilitation and communication, and staff worked with other health professionals.
- Caring?
- Good
- Staff knew people well and supported their choices, communication, dignity and independence. Inspectors did observe one person being assisted with feeding equipment in a communal area in a way that was not dignified.
- Responsive?
- Good
- Care plans were detailed and regularly reviewed. People had activities and community opportunities, but some plans needed clearer guidance about culture, mental health and sexual needs, and end of life planning could be developed.
- Well-led?
- Good
- The manager and provider had strengthened audits, oversight and improvement work since the previous inspection. Staff, residents and relatives expressed confidence in the management team.
What inspectors found, February 2020
Shaftesbury Treetops: Rated Good; inspectors found caring, safe support and improvements since the previous inspection, with some care guidance still needing development.
This was an unannounced inspection on 24 and 27 January 2020. Inspectors spoke with residents, relatives, staff and the manager. They observed care and checked care plans, medicines records, recruitment files, staffing rotas and quality checks.
The home was rated Good overall and Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough staff to meet people's needs, suitable training, detailed care plans, safe medicine systems and a clean, accessible environment.
People and relatives spoke positively about the care. Staff supported communication, independence, healthcare, meals, activities and links with the community. The previous rating was Requires Improvement, but inspectors found that medicines management and oversight had improved.
Inspectors identified some areas for improvement. Guidance about diabetes emergencies, some care plan topics, dignity during feeding and end of life preferences needed further work. These issues did not change the Good ratings.
Positive experience
People and relatives spoke highly of the care and support. Inspectors found a strong person-centred culture.
“People and relatives spoke highly of the service and the quality of the support provided.” from the report
Improved medicines management
Medicine systems had been strengthened. Records, staff training, competency checks and audits supported safer medicines administration.
“Medicine systems had been strengthened and clear processes were in place for the safe keeping and timely ordering and supply of medicines.” from the report
Communication and choice
Staff used different communication methods and technology to involve people in decisions and support their independence.
“Staff adapted their approach when communicating with people to ensure they were involved, and their voice heard.” from the report
Activities and community links
People were supported to follow their interests, attend activities and spend time in the local community.
“People were supported to follow their interests and take part in activities they enjoyed both within the service and in the local community.” from the report
Diabetes guidance
needs fixingThe care planning included diabetes, but the guidance for staff about hypoglycaemia was not clear enough. The manager agreed to deal with this immediately.
“The management of people's diabetes was included as part of care planning but the guidance on managing incidents of hypoglycaemia could have been clearer.” from the report
Staffing vacancies
needs fixingThere were vacancies and agency staff were being used, although recruitment was under way and the manager said consistent agency staff were used where possible. One person felt the service was busier and staff did not always get a break.
“It feels busier, staff are running up and down and don't always get a break.” from the report
Some care plan gaps
needs fixingCare plans were detailed, but inspectors said staff needed clearer guidance about culture, mental health and sexual needs.
“The plans however would benefit from clearer guidance for staff on areas such as culture, mental health and sexual needs.” from the report
Privacy during feeding
needs fixingOne person was assisted with feeding equipment in a communal area. Inspectors said this was not dignified, and the manager agreed to address it immediately.
“However, we did observe on person being assisted with feeding equipment in the communal area which was not dignified” from the report
End of life preferences
minorSome people had recorded information about their end of life preferences, but the manager accepted that this area needed further development.
“Some people had information on end of their life preferences, but the registered manager acknowledged this was an area which could be developed further.” from the report
- 01What has been changed in the guidance for managing hypoglycaemia since this inspection?
- 02How many staffing vacancies are there now, and how often are agency staff used?
- 03How do you record and review each person's cultural, mental health and sexual needs?
- 04How will people receive privacy and dignity when they need feeding equipment?
- 05How are people's end of life wishes discussed, recorded and kept up to date?
This was an unannounced inspection covering all five key questions, with care and the premises both looked at. This explanation was written from the published report of 20 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, January 2019
Shaftesbury Treetops was Rated Requires Improvement; care was kind and responsive, but medicines and management checks were not reliable enough.
Inspectors made an unannounced visit on 13 December 2018. They observed care, spoke with people, relatives, staff and the manager, and checked care records, medicines, recruitment, complaints and quality checks. Follow-up calls with relatives took place between 13 and 18 December.
The home provided nursing and personal care for up to 21 people with physical disabilities, learning disabilities or acquired brain injuries. There were 17 people living there during the inspection. People and relatives spoke positively about the care, and inspectors saw kind and respectful interactions.
The main problems were with medicines records, equipment safety checks and the provider's quality monitoring. The medicines records were unclear and could have led to people receiving the wrong medicines. One piece of equipment used in emergencies had been missed from safety and cleaning checks.
The overall rating was Requires Improvement. Effective, caring and responsive were rated Good. Safe and well-led were rated Requires Improvement. The home was rated Good at the previous inspection in May 2016, but inspectors found that this standard had not been maintained.
Kind and respectful care
People and relatives spoke highly of the staff. Inspectors saw warm, friendly and attentive interactions.
“We observed that people looked relaxed in the company of staff and interactions were warm and friendly.” from the report
Good care planning
Care plans focused on people's needs, preferences and strengths. They were updated when needs changed and supported independence.
“Care plans were detailed and informative and were regularly updated to reflect changes in people's needs.” from the report
Support with health and nutrition
People's nutritional needs were assessed and professional advice was obtained when needed. People were supported to access health services.
“People were supported to access a balanced diet.” from the report
Activities and communication
People had social opportunities in the home and local community. The home used easy-read information and other communication tools.
“People had access to a range of social opportunities which promoted their wellbeing.” from the report
Medicines records
seriousMedicine administration records were unclear. They did not always show what had been given, and some medicines appeared twice, creating a risk of the wrong dose or medicine.
“People's medicines were not however always managed safely.” from the report
Equipment safety checks
seriousA suction machine used in emergencies had been missed from safety and cleaning checks. Staff could not clearly show that specialist mattress settings were known.
“We identified that the suction machine had not been included as part of these checks and this meant that people could be placed at risk in the event of an emergency.” from the report
Weak quality monitoring
needs fixingProvider audits did not identify the medicines and safety problems. Incident information was recorded but not properly collected and analysed for patterns.
“The provider had not undertaken regular quality audits to check on the implementation of its policies and ensure that the service continued to improve and develop.” from the report
Vacancies and agency staff
needs fixingStaffing met people's needs during the inspection, but the home had 6.5 vacancies and depended on agency staff. Some relatives said this affected the activities available.
“However, the service had a significant number of vacancies and was dependent on agency staff.” from the report
- 01What changes have been made to medicine administration records, including records for stock medicines, creams and handwritten entries?
- 02How often are the suction machine and other emergency equipment now checked and cleaned?
- 03How are specialist mattress settings and moving and handling instructions recorded and checked?
- 04How does the provider now audit the home and analyse incidents to identify patterns?
- 05How many permanent staff vacancies remain, and how will agency staffing affect activities and continuity of care?
This was an unannounced inspection covering all five key questions; it was prompted in part by a serious injury incident, but the report did not examine that incident because it was subject to a criminal investigation. This explanation was written from the published report of 24 January 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 Shaftesbury Treetops
3 rated inspections over 4 years: the service has held its Good rating throughout.
- February 2020Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2019Requires improvementdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- June 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2013
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- November 2010
Registered with the Care Quality Commission on 17 November 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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