About the service: Pine Tree Court is a residential care home that was registered to provide personal and nursing care for up to 40 people. At the time of our inspection 23 people aged 65 and over lived at the home. The home supported people who lived with nursing needs and/or dementia.

People’s experience of using this service:

• People and their relatives were positive about the quality of care provided. One relative said, “I can honestly say that the staff are good, they notice things and deal with the more difficult people, stay calm and cool without retaliation”.

• People were cared for by staff who were kind and caring. We observed staff frequently engaging with people in a respectful and friendly manner. The atmosphere of the home was bright and welcoming. Improvements had been made to the home’s decoration and environment to help people orientate themselves around the home.

• People were cared for by staff who knew how to keep them safe and protect them from avoidable harm. Plans were in place for staff to receive additional training to support them to effectively care for people.

• Sufficient staff were available to meet people's needs during the day. The acting manager was reviewing the availability of qualified night staff to ensure people remained safe at night.

• People received their medicines as prescribed as safe medicines management systems were being used.

• Incidents, accidents and complaints were investigated and actions were taken to prevent recurrence. Staff were given opportunities to reflect and share good practices.

• Effective infection control systems and regular servicing and maintenance checks of equipment and the premises were regularly carried out.

• People's care and support needs were assessed. Their care plans provided staff with the information they needed to support people. Staff encouraged people to make decisions about their care and have control of their lives.

• People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

• People’s individual risks were known and managed well by staff. Health care professionals provided positive feedback about the care and support people received.

• People were provided with a nutritious diet and drinks. They complimented the choice of foods. One person said, “I look forward to my food. I usually eat what’s on.”

• A new acting manager was in post. They were making significant progress in implementing new systems to improve the quality of care being provided. However more time was needed for systems and arrangements to be fully implemented and evaluated, such as further developing the activities programme to ensure people’s personal social and recreational needs were being fully met.

• Staff, people, relatives and other stakeholders praised the support and professionalism of the manager and felt confident in their vision, values and abilities.

The service met the characteristics of Good in four key questions and Requires Improvement in the key question ‘Is the service Well-led?’

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Requires Improvement (Last report was published on 8 May 2018). The overall rating for the service has improved from Requires Improvement to Good.

Following the last inspection, we asked the provider to complete an action plan to show us what they would do to meet the regulatory requirements and by when to improve the key questions, ‘Is the service safe and well-led?’ to at least Good.

We met with the provider on 5 September 2018 who told us about their action plans to improve people’s care records and the governance and monitoring of the home.

Why we inspected: We inspected this service as part of our ongoing Adult Social Care inspection programme. This was a planned inspection based on the previous Requires Improvement rating. We followed up on progress against ag

This inspection took place on 26 and 27 February 2018 and was unannounced. Pine Tree Court Care Home 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. Pine Tree Court provides accommodation for 40 people who require personal care with nursing. There were 19 people living in the home at the time of our inspection. The home provided personal care and support for people who lived with nursing needs and/or dementia. Pine Tree Court Care Home is set over three floors which are accessible by stairs or a lift. The home has three lounges and a dining room.

We last inspected in March 2017 and found that the provider was not meeting a number of the Health and Social Care Act 2008 regulations. This service has been in Special Measures. Services that are in Special Measures are kept under review and are inspected again within six months of the published report. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that sufficient improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Following our inspection in March 2017 we required the provider to carry out a monthly audit of the management of people’s medicines, equipment used to support people; the fire safety of the home, staff development, people’s care records and the governance of the home. The provider was required to send the Commission a monthly written report of the results of each audit and any actions taken. Since imposing the condition, CQC has been monitoring the provider’s monthly reports and progress. At this inspection in February 2018, we followed up on their actions and found many improvements had been made, however some further progress was still required to ensure people received effective care and to ensure the home was well run.

There was no registered manager in post as required by their conditions of registration. However a new manager had been employed and was in the process of applying to be registered with CQC. 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.

Whilst we found improvements had been made in the areas we had identified as requiring improvement, we found some ongoing shortfalls in the recording of the management of people’s risks. Further development of records relating to staff professional development and the monitoring of their advance training requirements to support people with complex needs were required. These shortfalls had not all been identified by the provider’s internal quality monitoring systems and further improvement was needed to ensure shortfalls would always be identified.

We will continue to ask the provider to undertake regular audits in relation to people’s care records and staff development and to send a monthly report to the Commission detailing the outcome and improvements made.

Significant improvement had been made to the home’s environment, the fire safety systems and the equipment used to support people. People enjoyed a home which was safe, clean and homely. People received care and support which was responsive to their needs. Staff were aware of people’s likes, dislikes and support needs. Improvements had been made to the recording of the management of people’s care. Detailed mental capacity assessments and best interest decisions had been recorded to protect people’s human rights.

People were supported by an established staff team who were familiar with th

This inspection took place on 20 and 28 March 2017 and was unannounced. Pine Tree Court Care Home provides accommodation for 40 people who require personal care with nursing. There were 22 people living in the home at the time of our inspection. The home provided personal care and support for people who lived with nursing needs and/or dementia. Pine Tree Court Care Home is set over three floors which are accessible by stairs or a lift. The home has three lounges and a dining room.

There was no registered manager in place as required by their conditions of registration. 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. However a manager was in place who had recently submitted an application to CQC to become the home’s registered manager.

We last inspected in July 2016 and found that the provider was not meeting a number of the regulations. Following our inspection the provider sent as an action plan of the actions they would take to meet the legal requirements. During this inspection we found some improvements had been made, however further improvement was still required to ensure people received safe and effective care and the home was well run.

People and their relatives were positive about the care they received and the meals they received. They told us staff were kind and looked after people well. People were referred to other health care professionals when their needs had changed. A range of activities were available in the home however people’s individual social and recreational well-being needs were not always met.

People’s care needs were mainly managed well and recorded. However, more detailed guidance was needed to assist staff with the management of people’s risks. Some pieces of equipment used to support people were not fit for purpose and alternative strategies had not been identified. People and their relatives had been involved in their care planning, although processes were not in place for relatives to lawfully sign for people’s care plan and associated records.

There was adequate recruitment systems in place to ensure staff had been suitably checked before they started to support people. People were supported by sufficient numbers of staff although the staffing levels of non-care staff at the weekends and in the evenings were variable, however we found no impact on people. The provider and manager did not always have a clear understanding of the skills and training needs of staff. Staff told us they felt supported but did not always have effective private meetings with their managers to discuss their personal development and objectives.

The manager had investigated and responded to complaints but had not always recorded the details and outcomes of their investigation. The provider had implemented a series of auditing tools to monitor the quality of the service being delivered, however the actions required was not clear when concerns had been found.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of this report.

The overall rating for this service is ‘Requires Improvement’. However we are placing this service in ‘special measures’. We do this when services have been rated ‘inadequate’ in any key question over two consecutive comprehensive inspections. The ‘inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

Services in special measures will be kept under review and, if we have not taken immediate actions to propose cancel the provider’s registration of the service, will be inspected ag

This inspection took place on 28 and 29 July 2016 and was unannounced. Pine Tree Court Care Home provides accommodation for 40 people who require personal care with nursing. There were 26 people living in the home at the time of our inspection. The home provided personal care and support for people who lived with nursing needs and/or dementia. Pine Tree Court Care Home is set over three floors which are accessible by stairs or a lift. The home has three lounges and a dining room.

There was no registered manager was in place as required by their conditions of registration. 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. However a manager was in place who had recently submitted an application to CQC to become the home’s registered manager.

People and their relatives were mainly positive about the care they received however we found people’s safety and well-being was compromised in a number of areas.

People’s care records were generally up to date; however they did not always provide staff with relevant and detailed information about their personal histories and social interests. People’s individual support requirements in the event of a fire had not been thoroughly assessed. The risks associated with their care had been assessed and regularly reviewed but recommendations to monitor some people further were not always implemented. People’s medicines were managed and stored well. People were given their medicines on time however there were some inconsistencies in the recording of when people had received their medicines.

People’s personal interests and social needs were not always met. The decoration of the home did not support people living with dementia. The home had not been adequately maintained, although plans were in place to refurbish the home. People’s mental capacity to make significant decisions had not been thoroughly assessed or recorded, although some staff knew people well enough to understand their preferences. Records of best interest decisions made on behalf of people were not in place.

On occasions there were not enough staff to meet people’s needs. People were not always being effectively supervised. The manager had not always explored the employment history of new staff to ensure people were being cared for by staff who were of good character. Staff were not consistently trained or supported to carry out their role.

People were supported by staff who were kind and compassionate and knew people well. They understood their responsibility to safeguard people and report any concerns. People enjoyed the meals provided. Those who had specific dietary needs were catered for.

Tools were being used to monitor the service being delivered, however there were not records of the actions that need to be taken to address any identified shortfalls. The provider visited the home regularly and provided support. Information and significant events were not consistently shared with CQC as required by law.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Care Quality Commission (Registration) Regulation 2009. You can see what actions we told the provider to take at the back of the full version of this report.

We carried out an announced comprehensive inspection of this service on 12 January 2015. A breach of legal requirements was found in relation to the documentation of people’s consent to their care and support. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Pine Tree Court Care Home on our website at www.cqc.org.uk.

At this inspection we found the improvements had been made in recording people’s consent to their care and support and the home now met the legal requirements.

People who lived in Pine Tree Court Care Home had advanced dementia and were not always able to understand information and make decisions for themselves. Staff knew people well and were able to support people in this process. Records showed that people had been assessed as lacking capacity to make decisions about their care and treatment. Minutes of meetings showed where significant people and health care professionals had worked together to make best interest decisions on behalf of people. The registered manager knew which people had legally authorised significant others to speak on their behalf about their well-being and finance.

This inspection took place on 12 January 2015 and was unannounced. Pine Tree Court Care Home provides accommodation for 40 people who require nursing and personal care. 31people were living in the home at the time of our inspection. Most of the people living in the home have been diagnosed with a type of dementia. This service was last inspected in May 2014 when it met all the legal requirements associated with the Health and Social Care Act 2008.

Pine Tree Court Care Home is set over three floors. The home has two lounges and a large dining room. A large conservatory is planned to be built this year.

A registered manager was in place as required by their conditions of registration. However a new manager was now running the home and was in the process of applying to CQC to take over the role as the registered manager. For the purpose of this report the manager running the home will be referred to as the ‘acting 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.

People had been involved in the planning of their care. People’s past histories and known preferences had been considered when they were unable to make decisions for themselves. Staff knew people well and were able to monitor and support people if they became upset. The acting manager and staff were aware of their responsibilities in recognising those people who may have their freedom restricted. However the details of some people’s mental capacity assessments were not always evident in line with legislation.

Opportunities for some people to take part in individual meaningful activities were limited, although people enjoyed external entertainers and some group activities. People were encouraged and supported to have a well-balanced and nutritional diet. They were encouraged to give feedback about the meals provided.

People who were able to express their views and relatives were positive about the care and support they received from staff. We observed that staff were kind and friendly when caring and speaking to people. People’s individual needs were assessed, planned and reviewed. They received additional care and treatment from other health care services when needed. People received their medicines in a safe and timely manner. Staffing levels were monitored to ensure there were sufficient trained staff meet people’s needs. Thorough recruitment checks and an induction programme were carried out with new staff before they were able to care for people. Systems were in place to ensure people were cared for by staff who received regular training and support from their line manager. Staff told us they were supported.

People were protected against abuse because staff knew how to report any concerns of abuse to the relevant safeguarding authorities. Risks for individual people had been assessed. Staff were given guidance on how to best support people when they were upset or at risk of harm. Staff had been trained to support and protect the people they cared for. Policies to protect people were in place to give staff guidance.

The acting manager had a good understanding of their role and managing the quality of the care provided to people. Quality monitoring systems were in place to check and address any shortfalls in the service. People and their relatives felt that any concerns raised were dealt with immediately.

You can see what action we told the provider to take at the back of the full version of the report.

Our inspection of 5 November 2013 found people's needs in relation to their daytime activities had not been fully planned or delivered. The provider wrote to us and told us ‘life style diaries’ would be developed for each person’s individual interests and hobbies. Additional funding would be made available for external entertainment and activity co-coordinator hours would be increased. The provider told us that these changes would be implemented by 3 February 2014.

We were unable to ask people about their views of living in the home because people had a diagnosis of dementia and this limited their ability to verbally communicate. However, we observed staff interaction with people throughout our visit, spoke with six members of staff and looked at six people’s care records.

We found the compliance action set in November 2013 was met. We observed some people take part in a singing activity with an external entertainer and staff spending one-to-one time with other people talking, reading or giving hand massages. People’s care records had been updated to reflect their needs and wishes in relation to daytime activities. People’s care records also detailed what activities they had taken part in each day.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location. The cancellation of this manager was being processed at the time of the inspection.

In this report the names of registered managers appear who were not in post and not managing the regulatory activities at this location at the time of the inspection. Their names appear because they were still a registered manager on our register at the time of this inspection. We have advised the provider of what they need to do to remove these individuals’ names from our register.

Our inspection of 5 June 2013 found that up-to-date information for staff to follow to ensure people’s safety and welfare was not always recorded in care records. People who were not able to participate in activities were not always given one-to-one time with staff to meet their social and emotional needs. The provider told us that care plans for people would be reviewed and updated to reflect each individual’s needs. The provider told us that these changes would be implemented by 30 September 2013.

We were unable to ask people about their views of living in the home because people had a diagnosis of dementia and this reduced their ability to verbally communicate. However, we observed people in one of the lounges throughout the day and in the dining room during the lunchtime period.

We found that care records had been updated since our visit in June 2013 to accurately reflect people’s needs in relation to their physical health and personal care needs. However, we found that peoples’ needs in relation to their daytime activities had not been fully planned or delivered.

In this report the name of registered managers appear who were not in post and not managing the regulatory activities at this location at the time of the inspection. Their names appear because they were still a Registered Manager on our register at the time of this inspection. Applications to cancel these registered managers names had been received but were still being processed at the time of the inspection.

We were unable to ask most people about their views of living in the home because people had a diagnosis of dementia and as a result had some communication difficulties. However, we observed that staff understood the best way to communicate with people and were able to support people to make choices about their daily living. People who could express their views told us, “they (staff) look after me, they are good here” and “I can get up and go to bed when I want to”.

We looked at the care plans for seven people and saw that these were regularly reviewed. However, not all had been sufficiently updated to reflect people's current needs. Communal areas were crowded and we observed occasions during our visit when there were not enough seats for people. We saw that activities were provided for people and those who could participate seemed to enjoy them. People who were not able to participate were not always given one-to-one time with staff to meet their social and emotional needs.

There were enough qualified, skilled and experienced staff to meet people’s needs.

Helen Buncombe was the registered manager for this location. The previous manager’s name was still showing on the report because at the time of our visit an application to cancel this registration had not received.

During our visit we spoke with four people living in the home and spent time observing people in the communal areas. People we spoke with told us they were happy living in the home and were able to make choices about their daily living. We saw that staff interactions were respectful and were at the pace of the person they were working with. A relative we spoke with told us “I am happy with the home, it is not too regimented”.

Care plans were personalised to each individual's needs and detailed how staff should work with people to meet those needs. Risk assessments had been completed where necessary and all care records were reviewed monthly. Staff were appropriately trained and showed good knowledge of the people they cared for. One person told us “staff are very good, I have no complaints”.

Consent for care and treatment was consistently sought from people or their relatives who acted on their behalf. Care was provided in an environment that was safe, well maintained and met people’s needs.

The staff knew about people's individual preferences and were able to tell parts of people's life stories. One person told us, "they treat us like individuals".

The local authority's Quality Assurance team had told us prior to our visit that they had very few concerns about this service at the moment, particularly since the new manager had taken over.

People that we spoke with said they felt safe. One person said, "if I've got a problem I go to the manager". Another person told us that after visiting their relatives in the home, they had "no problem leaving them, we know they're safe".

One relative, speaking about the manager, told us, "we can go to her any time". People told us that they felt listened to when they had concerns - one person living at the home told us the manager "tries her hardest and she listens to us".

Staff that we spoke with were able to speak confidently about the care practices they delivered. They demonstrated a good understanding of how the care they delivered contributed to people's health and wellbeing.

People told us that they were asked their views about the service. Some people told us that they had been asked to complete a survey about the service.

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with six people who use the service, two visitors, the registered manager, five care staff and two other staff involved in the provision of the service to people. We also reviewed records relating to the management of the home which included, four care plans, daily care records, accident and incident records, quality assurance systems and staff rotas. Concerns had been raised with us prior to the inspection about staffing levels impacting on the quality of care, people’s health and well-being being put at risk due to lack of food, poor continence and increasing falls. We found although staffing levels had reduced so had the number of people living in the home from 40 to 27. The provider had strategies in place for people at risk of malnutrition, incontinence and falls.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

People were safe because emergency procedures were in place should they be needed to protect them from harm. Where people needed help or support to evacuate the building this had been identified. Emergency plans provided staff with information about how to respond to emergencies and keep people safe.

Accidents and incidents were being monitored for any trends which impacted on people’s safety. Where necessary the appropriate action was taken to prevent these happening again such as referrals to health professionals to investigate their mental or physical health or providing equipment to safeguard people from falls. This meant the provider was taking action to keep people safe.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications needed to be submitted proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

People were safe because staff knew what to do when safeguarding concerns were raised and they followed policies and procedures. People understood what keeping safe meant and one person told us, “I feel safe, life is good if I am left alone by others living here.” A visitor said, “I feel people are safe”.

People were safe because staffing levels were assessed and monitored to ensure they were sufficient to meet their identified needs. A visitor told us, "Staff are always busy but they come straight away if you need them." People told us, "Staff are good fun", "I have no complaints about anybody".

Is the service effective?

People received an effective service because staff had a good understanding of their needs. People’s individual needs, choices and preferences were reflected in their care plans. Visitors told us, "the care is second to none", "everyone knows the patients here, they are responsive to their needs", "staff are wonderfully patient".

People, especially those with complex needs, were effectively assessed to identify the risks associated with nutrition and hydration. People had access to dietary and nutritional specialists where needed. A choice of suitable and nutritious food and drinks were provided in sufficient quantities. People told us, "food is excellent”, “food is lovely" and staff said, "I never hear complaints about food", "plenty of food and snacks around people help themselves".

People’s health was regularly monitored to identify any changes that might require additional support or intervention. Referrals were quickly made to health services when people’s needs changed.

Is the service caring?

People received a service which was caring because staff knew the people they were caring for and supporting, including their preferences and personal histories. Staff showed concern for people’s well-being. Staff were observed taking time to communicate with people sensitively and in a meaningful way.

As people’s needs changed, staff knew how to manage their care appropriately in line with their choices and wishes. A member of staff commented, "We work well as a team.” We observed staff being attentive to people and responding to them kindly and patiently. A visitor told us, “Staff are excellent, they have wonderful patience, treat people wonderfully.”

Is the service responsive?

A responsive service was provided because people had their individual needs regularly assessed and met. They received support and care when they needed it. A visitor said, "Staff are always busy but they come straight away if you need them."

People had access to activities that were important and relevant to them. We observed them enjoying a singer entertaining them. Individual as well as group activities were planned so that everyone could be involved in activities they enjoyed.

We observed visitors spending time with people and choosing where to spend time with them. People and their relatives knew how to make a complaint. A visitor told us, “On the odd occasion I have raised a concern she (the registered manager) has acted straight away.”

Is the service well led?

The service is well led because the provider actively seeks the views of people, others important to them and staff to assess the quality of the service provided. They listen to people’s feedback and take action to improve the service as a result. The providers had a range of quality assurance tools and audits in place to assess and monitor the service. This meant the robust quality assurance and governance systems were used to drive continuous improvement.

Staff understood what was required of them. They understood their roles and responsibilities. Visitors commented, "Very good staff and management", "We are kept well informed."