CQC report explained · a nursing home
What the CQC found at Tall Trees Glade
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found that risks were assessed and managed, medicines were given safely, there were enough staff, and safeguarding and infection control processes were in place.
- Effective?
- Good
- People's needs were assessed and care plans were updated. Staff had suitable induction, training and supervision, and people were supported with food, drink and healthcare.
- Caring?
- Good
- This question was not looked at during this focused inspection. Its previous rating was carried forward when calculating the overall rating.
- Responsive?
- Good
- This question was not looked at during this focused inspection. Its previous rating was carried forward when calculating the overall rating.
- Well-led?
- Good
- Inspectors found clearer management arrangements, better quality audits, improved oversight and good partnership working. People, relatives and staff reported better communication and support.
What inspectors found, December 2021
Rated Good after major improvements, although inspectors noted continuing changes in management and no registered manager was in post.
This was an unannounced focused inspection on 27 October and 10 November 2021. Inspectors looked at whether the home was safe, effective and well-led. They spoke with people, relatives, staff and a healthcare professional, observed care, and checked care and medicine records.
The home was rated Good overall, with Good ratings for Safe, Effective and Well-led. Inspectors found better risk assessments, safe medicines management, enough staff, suitable infection control and improved quality checks. Staff knew how to protect people and work with healthcare professionals.
The home had previously been rated Requires Improvement, with three breaches of regulations. Inspectors found the provider had made enough improvements and was no longer in breach. The ratings for Caring and Responsive were not assessed during this focused inspection and were carried forward from the previous comprehensive inspection.
Safer medicines
Medicines were stored, given and recorded safely. Staff were trained and their competence was checked regularly.
“At this inspection improvements had been made and medicines were managed safely.” from the report
Enough staff
Inspectors saw that people were attended to promptly and staff were not rushed. Staffing levels were reviewed as people's needs changed.
“The service had enough staff to meet people's needs.” from the report
Better quality checks
The provider had improved its audits and used them to monitor care, medicines and safety.
“The provider's quality assurance systems had significantly improved. The staff team assessed the quality and safety of the service through audits.” from the report
Good support at mealtimes
People were supported with food and drink in a dignified way. Mealtimes were not rushed and people could choose to eat in their rooms.
“People were supported with nutrition and hydration in a dignified way.” from the report
Management stability
minorThe home was led by an interim manager and had recently appointed a new manager. Inspectors recorded concerns that repeated management changes had caused disruption and that staff wanted more stability.
“However the frequent changes in management have led to some degree of disruption.” from the report
No registered manager at the visit
minorThere was no registered manager in post when inspectors visited. The report says a newly appointed manager was expected to register with CQC.
“There was no registered manager in post. A registered manager is a person who has registered with the CQC to manage the service.” from the report
- 01Who is the registered manager now, and has the new manager registered with CQC?
- 02How are you making sure the improvements to medicines management and risk assessments continue?
- 03How often do managers and senior staff change, and what support is in place during any change?
- 04How do you check that staffing levels remain enough when people's needs change?
- 05What was the previous rating for Caring and Responsive, and what has changed in those areas since that inspection?
This was an unannounced focused inspection of Safe, Effective and Well-led; Caring and Responsive were not assessed and their previous ratings carried over into the overall rating. This explanation was written from the published report of 15 December 2021 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 2021
Overall Requires Improvement; the safe rating was Inadequate because inspectors found risks with medicines, staffing, safeguarding and care records.
This was an unannounced focused inspection on 26 May 2021. Inspectors looked only at Safe, Effective and Well-led. They reviewed records, spoke with people, relatives, staff and health professionals, and observed care.
The home was not consistently safe. Medicines were not always managed properly. Risk assessments and care plans lacked important instructions. Staffing was sometimes below the provider's own assessed level, and action was not always taken promptly after an allegation of abuse.
Care and treatment were not always effective or person-centred. Advice from health professionals was not always added to care plans. Some staff records had training gaps, and people said their preferences and complaints were not always acted on.
The overall rating remained Requires Improvement. Safe fell from Requires Improvement to Inadequate, Effective fell from Good to Requires Improvement, and Well-led remained Requires Improvement. The report says earlier problems were still not fixed.
Recruitment checks
Inspectors found that staff recruitment was carried out safely, with the required checks completed before staff started work.
“Staff were recruited in a safe way. All appropriate checks were carried out prior to members of staff commencing work for the service.” from the report
Dementia-friendly setting
The home had adapted its environment for people living there, including clear colour contrasts and accessible communal areas.
“The service was dementia friendly. The environment within the home had been adapted to meet the needs of people who lived there.” from the report
Consent and decision-making
Inspectors saw staff asking for consent before care. Formal mental capacity and best-interest decisions had been completed for significant decisions.
“Staff received training to help them understand their role in supporting people's day-to-day decision making. We saw they sought people's consent before carrying out their care.” from the report
Some infection controls
Inspectors were assured about several infection control arrangements, including PPE, testing, social distancing and visits.
“We were assured that the provider was using PPE effectively and safely.” from the report
Medicines and health risks
seriousSome medicines were not recorded safely, and care plans did not always explain how to manage conditions such as diabetes. Inspectors said this could lead to deterioration or emergencies.
“This posed a risk of lack of control over people's condition, risk of deterioration, complications and diabetic emergencies.” from the report
Safeguarding response
seriousSenior staff did not act promptly after an allegation of abuse. The safeguarding policy did not clearly say who should act or when an alleged abuser should be suspended.
“During our inspection we found prompt action had not been taken by senior staff within the home to protect people from the risk of abuse.” from the report
Staffing and call bells
seriousPeople and staff reported that there were not enough staff. One person's call bell was out of reach and not connected, meaning they could not reliably ask for help.
“This meant the person in question could not request assistance from staff when needed.” from the report
Incomplete care planning
needs fixingRisk assessments and care plans did not always explain how staff should recognise or respond to important risks. Professional advice was also not always added to care records.
“Risk assessments and care plans did not always provide staff with information on how to recognise and how to act on potential risks to people.” from the report
Weak management oversight
needs fixingAudits did not control key risks, and earlier problems with medicines and leadership were still unresolved. Complaints were not always recorded or investigated.
“Systems and processes were not effectively operated to monitor and improve the quality and safety of support provided.” from the report
- 01What has changed since the inspection to make sure medicines, including topical creams and diabetes medicines, are managed safely?
- 02How do you now ensure there are enough staff on each shift, including enough registered nurses, and that call bells are connected and within reach?
- 03What is your current process for responding immediately to allegations of abuse and deciding whether staff should be suspended?
- 04How are risk assessments and care plans checked to ensure they contain current advice from doctors and other health professionals?
- 05How are complaints from people and relatives recorded, investigated and followed up?
This was a focused inspection of Safe, Effective and Well-led only; Caring and Responsive were not inspected and their previous ratings were used. This explanation was written from the published report of 7 October 2021 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 Tall Trees Glade
7 rated inspections over 7 years: the service has improved, from Requires improvement to Good.
- December 2021Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2021Requires improvementstayed Requires improvementSafe: InadequateEffective: Requires improvementWell-led: Requires improvement
- December 2020Requires improvementdown from GoodSafe: Requires improvementEffective: GoodWell-led: Requires improvement
- April 2019Goodstayed GoodSafe: GoodEffective: GoodWell-led: Good
- April 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2016Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- April 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- May 2014
Report published without a new overall rating.
- July 2013
Registered with the Care Quality Commission on 4 July 2013.
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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