Treelands is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection

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

This inspection took place on 11, 17 and 18 January 2017. Our visit on 11 January was unannounced. We last inspected the home in October 2015. At that time we rated the service ‘Good’ overall.

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

Most people we spoke with were satisfied with the care they received. The comments we heard included “It is OK here”; “Most of the time you can do what you want. Sometimes there is not enough staff to help you do what you want to” and “The staff are very kind.” Two people commented independently of each other how much they had enjoyed their meal on Christmas day.

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.

During our inspection we spoke with four people living at Treelands Care Home. People told us about the choices they had around their daily activities and described the trips that they went on. We were told people who were able went shopping or to the seaside.

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.

This was an unannounced inspection that took place on 13, 14 and 15 October 2015. There were 72 people using the service at the time of the inspection.

Treelands Care Home is registered to provide accommodation and care, including nursing care, for a maximum of 80 people who may also have a dementia related condition. The accommodation is provided on two floors and comprises of, the Sycamore unit providing care and support to those people requiring residential care only, Beech unit providing care for younger adults with more complex needs, Oak unit providing residential nursing care and Elm unit providing care and support to those people living with varying levels of dementia. There are garden areas and a car park available for visitors.

At our inspection in February 2015 we had some concerns about the administration and disposal of medicines. We also had concerns about parts of the building which had not been properly maintained and the lack of appropriate and effective systems to monitor the quality of service delivery to those people using the service. Following that inspection, we produced a report and set the provider compliance actions to address the concerns raised. The provider sent us an action plan telling how they intended to address the concerns we had raised and to ensure compliance with regulation was achieved.

This inspection was a comprehensive inspection in order to provide the service with an overall rating. We also checked to see if compliance had been achieved in those areas we had concerns about at the inspection carried out in February 2015.

There was a registered manager in post who had been registered with the Care Quality Commission at this location since 22 December 2014. 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 and associated Regulations about how the service is run.

We found that systems for managing medicines was safe and we saw how staff worked in collaboration with other health and social care professionals to make sure people received support and treatment that met their individually assessed needs.

We looked at how staff were recruited within the home and checked five staff personnel files. We found the system was robust enough to make sure only suitable people were employed to work in the home.

Regular visiting health and social care professionals told us they were happy and confident in the service being provided to people living in the home.

We found that staff had a good understanding of the needs of the people they were supporting and caring for. Our observation of staff’s interaction with people living in the home showed they treated people using the service with respect and dignity and provided individual care as discreetly as possible.

People’s care records and information contained enough details to guide staff on the care and support the individual person required. The records also demonstrated that risks to people’s health and well-being had been identified and plans were in place to help reduce or eliminate the risk.

We checked to see if people were provided with a choice of suitable and nutritious food and drink to make sure their health care needs were being appropriately met. People told us they enjoyed the meals and choices were made available to them.

On one particular unit there was a person using the service whose first language was not English. We saw that one member of staff who spoke the same first language, made sure they had regular chats with the person so they didn’t feel isolated.

Equipment such as hoists, adapted wet rooms and other aids and adaptations such as pull down handles in toilets had been fitted around the home and were available to help and promote people’s independence, safety and comfort where possible.

Systems were in place to demonstrate that regular checks had been undertaken on all aspects of the management of the service. The registered manager and deputy manager provided us with evidence of some of the checks that had been carried out on a daily, weekly and monthly basis.