CQC report explained · a nursing home
What the CQC found at Treetops Court Care Home
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, October 2022
Rated Requires Improvement; inspectors found ongoing risks with building checks, medicines and management oversight, after five consecutive Requires Improvement ratings.
This was an unannounced, focused inspection on 14 and 16 June 2022. Inspectors spoke with people, relatives and staff, and checked care records, medicines records, recruitment files, audits and policies. They looked only at Safe, Effective and Well-led.
The home had made enough progress to no longer breach the safe care and treatment regulation. However, building safety checks were not completed consistently. Medicines audits and records were not reliable enough, and some medicines had not been disposed of correctly. Staff recruitment checks were completed, but not all staff had the specialist training needed for everyone living there.
Inspectors found that mental capacity assessments did not always follow the legal framework. Management systems did not identify and deal with risks effectively. The home was rated Requires Improvement overall, and has held this rating for the last five inspections.
Safeguarding
Most people and relatives said they felt safe. Staff knew how to report safeguarding concerns.
“Staff knew where the safeguarding policies were kept and understood how to keep people safe; they knew when to report concerns and who to report them to.” from the report
Food and drink
People were offered choices, extra portions, drinks and snacks. Staff supported people to eat and drink when needed.
“We observed people being offered more food and drink throughout their meals as well as drinks and snacks being offered throughout the day” from the report
Infection control
Inspectors were assured that infection control arrangements, including PPE, testing, visiting and outbreak management, were in place.
“We were assured that the provider was making sure infection outbreaks can be effectively prevented or managed.” from the report
Person-centred activities
The home used a wish tree to record and grant people's wishes.
“A 'wish tree' was an initiative used to encourage meaningful person-centred outcomes for people” from the report
Building safety checks
seriousFire system, fire door, shower head and water temperature checks were not completed consistently. Records did not always show whether identified faults had been dealt with.
“Regular building safety checks were not consistency completed, and it was not clear if identified faults had been addressed.” from the report
Medicines management
seriousDiscontinued medicines had not been disposed of correctly, and inspectors found discrepancies in medicine stock records. This meant people might not always receive medicines as prescribed, although no one had been harmed.
“Discontinued medicines had not been disposed of in line with national guidelines.” from the report
Mental capacity decisions
needs fixingSome mental capacity assessments combined several decisions instead of considering each decision separately. The provider could not be sure that decisions were made lawfully and in people's best interests.
“This meant the provider could not be assured people's decision-making was being assessed in line with the legal framework nor if decisions were being made for people in their best interest.” from the report
Specialist staff training
needs fixingNot all staff had completed training in dementia care or supporting people who were distressed.
“Not all staff completed specialised training to meet the needs of all people living in the care home.” from the report
Management oversight
seriousQuality audits did not reliably identify medicines, environmental and incident-related risks. The provider's action plan had outstanding actions and improvements had not become consistent.
“Effective quality assurance systems were not in place to mitigate risk of harm to people in the care home.” from the report
- 01What has been done to ensure weekly fire system, fire door and water temperature checks are completed and recorded?
- 02How are medicines audits now checked to make sure stock records are accurate and discontinued medicines are removed safely?
- 03What specialist dementia and distressed-behaviour training has each member of staff completed?
- 04How are mental capacity assessments now made decision-specific and linked to best-interest decisions?
- 05What actions from the previous improvement plan are still outstanding, and how will you show that improvements are being sustained?
This was an unannounced focused inspection of Safe, Effective and Well-led; Caring and Responsive were not inspected and their previous ratings carried over into the overall rating. This explanation was written from the published report of 20 October 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 2020
Rated Requires Improvement; inspectors found risks with infection control, medicines and records, and issued a warning notice.
This was a focused inspection after concerns about infection control, staffing and safeguarding. Inspectors visited on 10, 11 and 14 September 2020. They spoke with people, staff and managers, and checked care records, medicines, training and management records.
The home was not consistently keeping people safe. Staff did not always follow protective equipment guidance. Some risks were not properly managed, medicines were not always given safely, and staffing arrangements did not always meet people's needs. Records did not always accurately reflect people's care needs.
The new management team had started improvement work and staff described the manager as approachable. However, the new systems had not yet been fully embedded or sustained. The overall rating remained Requires Improvement, as did Safe and Well-led. The other three areas were not inspected during this visit.
Safeguarding
People were safeguarded from suspected abuse. Staff understood how to recognise and report concerns, and the manager had improved oversight of safeguarding issues.
“People were safeguarded from the risk of suspected abuse and the provider had learnt lessons when things went wrong.” from the report
Open management
People and staff said the manager was approachable. Inspectors found a more open culture, with staff able to raise concerns and learn from mistakes.
“The manager had implemented new systems and improved the culture at the service to ensure staff felt able to raise any concerns.” from the report
Working with professionals
The manager had developed good working relationships with other professionals to support people's health and wellbeing.
“The manager had developed good working relationships with professionals to ensure people's health and wellbeing needs were maintained.” from the report
Infection control
seriousStaff did not consistently use or dispose of protective equipment correctly. Inspectors saw practices that increased the risk of cross infection.
“Staff were not consistently following the correct Personal Protective Equipment (PPE) guidance to protect people from the risk of cross infection.” from the report
Medicines and care risks
seriousMedicines were not always managed safely. Inspectors also found conflicting or incomplete records about repositioning, personal care, bowel monitoring and catheter care.
“People were placed at risk of unsafe care and treatment and the above evidence demonstrates a breach of Regulation 12 of the Health and Social Care Act 2014 (Regulated Activities) Regulations 2014.” from the report
Staffing
needs fixingStaff were not always deployed effectively. One person waited for help with eating, and another was not washed or dressed until after lunch.
“However, one person waited for their lunch because there were not enough staff deployed effectively to assist them to eat.” from the report
Care records
needs fixingSome records were not accurate or up to date. This created a risk that staff would provide inconsistent or unsafe care.
“Improvements were needed to ensure records contained an accurate and up to date reflection of people's needs.” from the report
- 01What changes have been made to ensure staff follow PPE and hand hygiene guidance every time?
- 02How do you now make sure medicines, including pain relief and creams, are given safely and at the right time?
- 03How are repositioning, personal care, bowel monitoring and catheter care records checked for accuracy?
- 04What staffing levels are now in place during busy periods, and how do you respond when someone needs help to eat or get washed and dressed?
- 05What evidence can you show that the improvements introduced by the new management team have been sustained?
This was a focused inspection of Safe and Well-led only; the other three key-question ratings were not inspected and previous ratings were used in calculating the overall rating. This explanation was written from the published report of 30 October 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.
Every inspection of Treetops Court Care Home
5 rated inspections over 6 years: the service has held its Requires improvement rating throughout.
- October 2022Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- October 2020Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- May 2019Requires improvementstayed Requires improvementSafe: GoodEffective: Requires improvementWell-led: Requires improvement
- October 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- January 2017Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- June 2016
Registered with the Care Quality Commission on 3 June 2016.
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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