Archived: Handsale Limited - Treelands Care Home Also known as Treelands Care Home

Treelands Care Home is registered to provide accommodation and care, including nursing care, for up to 80 people. At the time of our inspection there were 70 people living at the home. The accommodation is provided over two floors and is divided into four units: Sycamore unit provides care and support to people requiring residential care; Beech unit provides care and support for people with complex needs, such as mental health needs; Oak unit provides general nursing care and Elm unit provides care and support for people living with varying levels of dementia. The home is set within a large garden and there is a car park available for visitors.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

This was an unannounced inspection which took place on 27 and 28 March, 2018. We last inspected the service in January 2017. At that inspection we rated the service ‘Requires Improvement’ overall. We identified four regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. These were in relation to cleanliness, risk assessments, training, supervision, staff induction, weight monitoring, Deprivation of Liberty Safeguards, care plans and governance. At this inspection we found that improvements had been made and the service was no longer in breach of any of the regulations of the Health and Social Care Act (2008) Regulated Activities 2014.

We have made one recommendation about the provision of activities on Oak and Elm units.

There were systems in place to help safeguard people from abuse. Staff understood what action they should take to protect vulnerable people in their care. Recruitment checks had been carried out to ensure staff were suitable to work in a care setting with vulnerable people. At the time of our inspection there were sufficient staff to respond to the needs of people promptly.

The home was well-maintained, clean and decorated to a high standard. Adaptations, such as the addition of clear picture signage, had been made so that it was suitable to people living with a dementia. Procedures were in place to prevent and control the spread of infection. There were systems in place to protect staff and people who used the service from the risk of fire. Maintenance checks on services and equipment were up-to-date.

The management of medicines was carried out safely.

Staff had undertaken a variety of training which enabled them to carry out their roles effectively. They received regular supervision which provided them with opportunity to voice any concerns and plan their professional development.

Staff encouraged people to make choices and remain independent where they were able. The service was working within the principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).

People who used the service were complimentary about the home and staff. We observed kind and caring interactions between staff and people who used the service. The service had introduced an electronic care documentation system. We found that care plans and risk assessments were detailed and reflected the needs of each person.

A range of activities were provided throughout the home. However, people commented that there was a lack of stimulation and things to occupy people in a meaningful way on Oak and Elm units.

There was strong leadership from the home owner, registered manager and deputy manager. This had ensured that improvements required following our January 2017 inspection had been carried out. The management team was forward thinking and committed to finding new ways to develop the service and improve the quality of care and support provided at Treelands. Audits and quality checks were undertaken on a regular basis and any issues or concerns addressed with appropriate actions.

Treelands Care Home is a purpose built care home, registered to provide accommodation and care, including nursing care, for a maximum of 80 people. At the time of our inspection there were 72 people living at the home. The accommodation is provided on two floors and is divided into four units: Sycamore unit provides care and support to people requiring residential care, Beech unit provides care for younger adults with more complex needs, Oak unit provides residential and nursing care and Elm unit provides care and support for people living with varying levels of dementia. The home is set within a large garden and there is a car park available for visitors.

At the time of our inspection the registered manager had been suspended, pending an investigation and the deputy manager had temporarily taken over the role of manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The deputy manager was being supported in their role, temporarily, by a consultant from a private organisation which provides quality assurance support to healthcare providers.

Following concerns raised by the local NHS Clinical Commissioning Group (CCG) the provider had been instructed to submit an action plan to the CCG which showed how they planned to address the concerns and make improvements to the service. During our inspection we saw that the owners of the home had taken actions to address the concerns. They had enlisted help from both a consultant, and a registered manager from one of their sister homes, to help work through the action plan and implement improvements throughout the home. We saw that a considerable number of improvements had been made, but some were still on-going.

During our inspection we identified breaches of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to cleanliness, risk assessments, training, supervision, staff induction, weight monitoring, Deprivation of Liberty Safeguards, care plans and governance. You can see what action we told the provider to take at the back of the full version of this report.

We made one recommendation. This was in relation to seeking feedback from people who use the service and their relatives.

Although the home was generally well-maintained and decorated, we found that the kitchenette areas on two units and some equipment were not cleaned to a high standard.

We reviewed risk assessments, which help to identify potential harm to people, such as bed-rail risk assessments and those which identify if a person is at risk of developing pressure sores. However, these were not always in place or correct. This meant we could not be sure that risks to people's health were being safely managed.

During our inspection staffing levels were sufficient to meet the needs of people using the service.

Arrangements were in place to safeguard people from harm and abuse and recruitment processes were sufficiently robust to protect people who used the service from the risk of unsuitable staff being employed to care for them.

Medicines were stored and administered safely.

Through our review of staff records we found that staff had not received supervision on a regular basis. However, a new schedule for supervision had been devised and some supervision had recently taken place. No information about induction programmes for new staff was available so we could not be sure that new staff had received an adequate induction to their role.

There was limited information available about the training people had undertaken, although a training matrix giving overall insight into training was being compiled. Where gaps in training were identified the provider was taking steps to arrange the appropriate training sessions.

Staff sought consent to care and treatment from people they supported. However, Deprivation of Liberty Safeguards (DoLS) were not always in place, or up-to-date, when required. This meant the home was not working within the requirements of the Mental Capacity Act (2005).

On Sycamore unit some people had not had their weight regularly monitored. This meant there was a risk that people with problematic weight loss would not be identified promptly and the appropriate action taken. We brought this to the attention of the deputy manager and he took immediate steps to rectify this.

We received complimentary comments from people who lived at the home and from relatives about the staff and about the care and support they provided to people who lived at Treelands. People's dignity and privacy were respected and staff helped people to maintain their independence if they were able.

The care documentation we reviewed did not always reflect the current needs of individuals and some care plans were out of date. However, we saw examples that showed staff had been responsive to the individual needs of people who lived at the home, for example the introduction of a smoking cessation project.

There was a varied programme of activities at the home and there had been a recent initiative to encourage staff to take people to different units to take part in activities they might enjoy. However, on Oak unit we found that many people remained in bed throughout the day and risked becoming socially isolated.

People we spoke with knew about the complaints process and felt they could make a complaint if they needed to.

The provider was in the process of reviewing the management of the home in order to ensure there was robust leadership. Although concerns identified by the local NHS Clinical Commissioning Group had been dealt with, during our inspection we found further concerns which had not previously been identified.

We found that there were not sufficient systems in place to monitor the quality and standard of care provided, although the provider had taken steps to implement a new programme of audits and quality checks.

There were limited opportunities for people who used the service to give feedback about care they received. The deputy manager told us a survey was planned for 2017.

The deputy manager had introduced a number of new initiatives, such as daily meetings, to improve communication and these had been well-received by staff. Staff spoke positively about the changes that were taking place within the home.

We saw that staff were calm and pleasant with people and asked for permission before completing care tasks. People who were not able to make decisions for themselves were treated appropriately in line with the requirements of the Mental Capacity Act (2005).

We saw there were appropriate infection control policies and procedures and staff were aware of their responsibilities in preventing the spread of infections.

There were suitable arrangements in place to ensure that people with the relevant qualifications, skills and experience were employed within the service. We found that there were also sufficient numbers of staff on duty to meet the needs of people currently living at the home.

There was a complaints procedure in place and we were told that there had been no formal complaints in the last 12 months. However, we noted that there was no system for monitoring concerns that were raised. The manager stated that this would be rectified immediately.

One person told us that they needed assistance when having a shower, saying that staff treated them with dignity while providing personal care. Another person said they were able to get up and go to bed at whatever time they preferred. They said "I get up early, sometimes at 6am. I watch TV and someone brings me a cup of tea".

We saw care workers speaking to people in a respectful way and care was carried out discreetly. We spoke to staff who told us the management team could be approached at any time and they felt well supported at work.

We looked at medication records and saw that medication was stored securely. We saw that regular checks were carried out on medication to ensure it was being correctly dispensed and recorded.