About the service:

Treetops Court Care Home is a nursing home that was providing nursing and personal care to 66 people at the time of the inspection but was registered for up to 70 people. People may have had support needs in relation to their dementia or mental health. There were older and younger people using the service and some may have had a physical disability.

People’s experience of using this service:

Systems were not always effective at identifying areas for improvement although there had been many improvements since the last inspection. Documentation in relation to people’s mental capacity was not always personalised; action was taken immediately following our feedback.

Nationally-recognised best practice assessments were used to help monitor people’s health, although these had not always been effective. People were supported to access other health professionals.

Staff were recruited safely and there were enough staff to support people. Staff received training to be effective in their role and felt supported.

People had their risks assessed and planned for. People received their prescribed medicines and measures were put in place following our feedback about improvements that could be made.

People were protected as staff understood their safeguarding responsibilities and followed infection control procedures.

Lessons had been learned when things had gone wrong.

People were supported to have food appropriate to their needs. People enjoyed the food and had a choice.

The building was suitable for the needs of people and further improvements were planned.

People were treated with dignity and respect. People were involved in decisions about their care and supported to be as independent as possible.

People received personalised care that met their needs. Activities were available for people to partake in. People and relatives knew how to complain and felt able to; action was taken following a complaint.

People were supported at the end of their life and further work was planned to ensure plans contained sufficient personalised detail.

Relatives and staff all felt the service had improved since the last inspection. They felt positively about the registered manager and felt they could contribute to the running of the service.

The provider was proactive in supporting the service and they worked in partnership with other organisations and professionals.

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

Rating at last inspection:

At the last inspection the service was rated Requires Improvement (report published 20 October 2017).

Why we inspected:

This was a routine inspection planned on the previous rating.

Follow up:

We will continue to monitor the service and check improvements have been made at our next inspection.

The inspection took place on 27 and 28 July 2017 and was unannounced. Treetops Court Care Home is a residential and nursing home for up to 70 people who have a variety of support needs, such as a physical disability, dementia and mental health needs. There were 54 people living there at the time of the inspection, although one of those people was in hospital on the days of our visit.

There was a Registered Manager in post at the time of our inspection. 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, after our inspection the manager left so there was no longer a registered manager at the service.

At this inspection we identified continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People were not always protected from harm because we found incidents of alleged abuse had not always been reported to the local safeguarding authority.

Training was not always effective as safeguarding incidents had not been recognised, and we observed some examples of poor moving and handling. Records confirmed training was not up to date for all staff, and staff were not always recruited safely

Systems were in place to monitor the quality of the service; however these were not always effective. Although there were regular checks carried out by the registered manager, it was not always clear what documentation had been viewed. Incidents had not been identified, such as safeguarding incidents between people who lived at the service.

Staff were not always deployed effectively, people and relatives told us they sometimes had to wait for support and we saw that communal areas were sometimes left unattended.

Plans were not always in place to support people during periods of agitation. Staff did not always have guidance to follow in relation to people’s choking risks.

We observed some poor examples of moving and handling and clear guidance was not always available for staff. The administration of medicines was inconsistent, with some being given correctly and some not in line with guidance.

Not all of the principles of the Mental Capacity Act 2005 were being followed. Best Interest Decisions were not person specific. However, mental capacity assessments were being carried out and Deprivations of Liberty Safeguarding applications were made.

There was sometimes a delay in seeking support from other health professionals for some people to maintain their health and wellbeing. However some people were receiving timely support.

Care plans sometimes lacked detail and there was not always life history information available.

There was mixed feedback about the activities available for people to partake in, with some people thinking there was not enough to do whereas other’s enjoyed what was on offer.

The service could not always be caring as staff were not always deployed effectively. However, staff were kind and people’s privacy and dignity was respected and we saw staff offering people choices.

People told us they felt able to complain and we saw that complaints were responded to appropriately.

People were offered a choice of meals and told us they liked the food.

People told us they felt the registered manager was proactive and supportive, however the registered manager is no longer working at the home. The provider has told us a new manager would be starting. Staff told us they had supervisions and felt supported in their role. Notifications had been submitted about incidents which the registered manager had been aware of, which is a requirement.

Building checks were undertaken to ensure the environment was

The inspection took place on 23 August 2016 and was unannounced. Treetops Court Care Home is a residential and nursing home for up to 70 people who have a variety of support needs, such as a physical disability, dementia and mental health needs. There were 61 people living there at the time of the inspection.

There was a Registered Manager in post at the time of our inspection. 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.

At this inspection we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People were not always protected from harm because we found incidents of alleged abuse had not always been reported to the local safeguarding authority.

We found there were some gaps in the Medication Administration Records (MAR), so it was not clear whether people had received their medicine as prescribed.

Staff did not always have the effective training they required to assist someone who had challenging behaviour and this had left both people and staff at risk.

Risk assessments were in place to support people and staff however they had not always been followed or updated following a person’s needs changing.

Systems were in place to monitor the quality of the service; however these were not always effective. Although there were regular checks carried out by the registered manager, it was not always clear what documentation had been viewed. Incidents had not been identified, such as safeguarding incidents between people who lived at the service, the number of episodes of challenging behaviour some people were experiencing and staff needing to intervene and omissions in the medicines documentation.

There were limited activities available for people to partake in, with some people thinking there was not enough to do.

Accidents were documented and action taken and they were analysed for trends in order to prevent and reduce future occurrences and action had been taken after each accident.

Staffing levels were sufficient to meet people’s needs and staff had the appropriate checks in place to ensure they were safe to work with vulnerable people. Staff had the appropriate training to care for the people who lived in the home.

The principles of the Mental Capacity Act (MCA) 2005 were upheld and people’s consent was gained and appropriate people were consulted if someone lacked capacity. There were Mental Capacity Assessments in place and appropriate Deprivation of Liberty Safeguards (DoLS) application had been made.

People were offered a choice of meals and people told us they liked the food.

People had access to healthcare services and referrals were made when necessary to other professionals for their input.

Staff were caring and people’s privacy and dignity was respected. The registered manager and the staff knew people who lived in the home very well. People had things explained to them to offer reassurance and so they could make a decision, such as when they were being hoisted the staff clearly explained each step of their support.

People, relatives or representatives had been involved in the planning and review of their care and treatment.

There was regular opportunity for people, relatives and staff to feedback about the care, through a variety of different formats such as surveys, comment cards and in conversations with the registered manager. People also knew how to complain and were confident it would be dealt with if something was raised.

People told us they felt the registered manager was approachable and supportive. It was also evident that action had been taken if an issue was i