Spring Tree Rest Home

Spring Tree Rest Home is a residential care home that was providing personal care to 21 older people at the time of the inspection, some of whom were living with dementia.

The home accommodates up to 30 people in one purpose built building over three floors.

People’s experience of using this service and what we found

People were protected from the risks of ill-treatment and abuse as the staff team had been trained to recognise potential signs of abuse and understood what to do if they suspected wrongdoing.

People received their medicines as prescribed by trained and competent staff.

The provider had assessed the risks to people associated with their care and support. Staff members were knowledgeable about these risks and knew what to do to minimise the potential for harm to people.

People were supported by enough staff who were available to assist them in a timely way. Staff had received training which enabled them to support people effectively.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People had developed supportive and empowering relationships with those who assisted them.

People had care and support plans which were personal to their individual needs and desires.

People and staff felt Spring Tree Rest Home was well managed and were given opportunities to share feedback about the service. The registered manager and provider undertook regular checks to ensure the quality of care provided was good.

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

Rating at last inspection

The last rating for this service was good (published 02 April 2020).

Why we inspected:

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Spring Tree is a residential care home providing personal care to 17 people aged 65 and over at the time of the inspection.

The service can support up to 30 people in one adapted building across three separate floors.

People’s experience of using this service and what we found

The provider’s quality assurance and safety checks were not fully effective in identifying potential risks to people living at the home. Fire safety checks were not routinely carried out.

The provider did not have effective systems to learn lessons from accidents and incidents and when things went wrong. Actions taken to promote people’s safety were not always effective. There was no registered manager in place.

People were not always supported by skilled staff. Staff had not received relevant training in relation to their role and responsibilities. Staff were not supported through regular supervisions and appraisals.

Medicines were not always managed in a safe way and people’s risks were not always assessed and mitigated. Care plans did not consistently record the wishes and preferences of people.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Staff understood how to protect people from the risk of abuse and harm and staff understood and followed infection control processes. People and relatives told us they were happy with the care they received and felt the acting manager was approachable and would make the necessary improvements required.

Rating at last inspection

The last rating for this service was Good (published 28 November 2017).

Why we inspected

The inspection was prompted in part due to concerns received about the number of accidents and incidents that were occurring at the service, the provider’s lack of monitoring and oversight of people’s needs, medication errors and the provider’s lack of understanding and application of the Mental Capacity Act. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see all sections of this full report. You can see what action we have asked the provider to take at the end of this full report. The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

Enforcement

We have identified breaches in relation to good governance, safe care and treatment and staffing at this inspection. Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Spring Tree Residential Care Home can provide accommodation and support for up to 30 people who may be living with dementia. There were 22 people living there at the time of our inspection. The home accommodated people over three floors and on the day of our inspection the lift was being repaired; small lounge areas had been established on each floor and staffing had been reorganised to ensure they were staff available over each of the three floors. Following our inspection we received confirmation that the lift was now operational.

The service 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. At the time of the inspection a registered manager was in post.

We had received information that people may be at risk of harm. Our evidence demonstrated that staff understood their role in protecting people from the risk harm or abuse and the actions they needed to take if they had concerns. Where concerns had been identified the staff worked closely with other professionals to ensure these were investigated. People were confident that the staff supported them well. There were enough staff available to be able to support people. The staff were knowledgeable about people’s needs and understood the risks to people’s health and wellbeing. Recruitment checks were made before staff employment to confirm they were of good character and suitable to work in a care environment.

People could have food and drinks that they enjoyed throughout the day. People received support from health care professionals to help ensure their well-being was maintained and received their medicines as prescribed. Health concerns were monitored to ensure people received specialist health care intervention when this was needed.

Staff were kind and caring when supporting people and knew their likes and dislikes. People’s privacy was respected and the staff made visitors feel welcome and were approachable. There were processes in place for people to raise concerns and express their views and opinions about the service provided.

People were supported to have control of their lives and were supported in the less restrictive option possible. Staff understood people’s preferred communication method and the support they needed to make their own decisions. When people were unable to consent to specific decisions they were supported in their best interest.

Staff were kind and caring when supporting people and knew their likes and dislikes. People participate in social activities according to their interests. The staff and management team made visitors feel welcome and were approachable.

There were processes in place for people to raise concerns and express their views and opinions about the service provided. There were systems in place to monitor the quality of the service to enable the registered manager and provider to drive improvement.

Spring Tree is registered to provide residential care for up to 30 older people. Following the concerns we identified during our inspection visit in May 2015, we issued a condition on the provider’s registration to prevent further admissions into the home. On the day of our inspection visit 18 people were using the service. As a result of the improvements demonstrated by the provider at this inspection, we will remove this condition.

A registered manager from another home owned by the provider was managing the service. They were applying to become the registered manager of this service. 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.

Staff were available at the times people needed them and they had received training so that people’s care and support needs were met. People were protected from the risks of abuse because staff understood where harm may be caused and what action they needed to take. Where risks associated with people’s health and wellbeing had been identified, there were plans to manage those risks which meant people could continue to enjoy activities as safely as possible.

People made decisions about their care and staff helped them to understand the information they needed to make informed decisions. People received support in the ways they preferred and were encouraged to pursue their hobbies and interests. People liked the staff and had developed good relationships with them. People were supported to maintain relationships with people that were important to them and visitors were welcomed at the home.

People had a choice of food, and were encouraged to have enough to drink. People were referred to healthcare professionals to ensure their health and wellbeing was maintained. Medicines were managed so that people received their medication as prescribed.

Staff listened to people’s views about their care and people were able to influence the development of the service. People knew how to complain about their care and concerns were responded to. The provider and manager assessed and monitored the quality of care to ensure standards were met and maintained. They understood the requirements of their registration with us and kept us informed us important events that happened at the service.

• Ensure that providers found to be providing

inadequate care significantly improve.

• Provide a framework within which we use our

enforcement powers in response to inadequate care

and work with, or signpost to, other organisations in

the system to ensure improvements are made.

• Provide a clear timeframe within which providers must

improve the quality of care they provide or we will seek

to take further action, for example cancel their

registration.

This meant the service would be kept under review and inspected again within six months. We told the provider they needed to make significant improvements in this time frame to ensure that people received safe care and treatment that was responsive to their changing needs, were protected from abuse and not unlawfully restricted. We also told them that they needed to ensure that effective systems were in place to monitor the quality and safety of the service and to drive improvement.

At this inspection, we made the judgement that the provider had made sufficient improvements to take them out of special measures but some further improvement was needed to ensure the quality and safety of the service was effectively monitored.

Spring Tree Rest Home provides accommodation and personal care for up to 30 people who may be living with dementia. At the time of the inspection 19 people were using the service.

The previous registered manager had left since our last inspection. Another manager registered to manage another of the providers services was in place. 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.

Risks to people had not been assessed in relation to their individual needs. Some people were being restricted of their liberty due to the lack of effective risk assessments. People's care was not always based on their individual needs. People's preferences were not always respected and their independence was not promoted.

We found the provider continued not to work within the guidelines of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty safeguards (DoLS). The (MCA) is designed to protect people who cannot make decisions for themselves and lack the mental capacity to do so. The (DoLS) are part of the MCA. They aim to make sure that people in care homes are looked after in a way that does not inappropriately restrict their freedom. We found that although DoLS referrals had been made for all the people who used the service, people's capacity to make decisions and consent to their care had not been assessed.

Some improvement were seen in the safe management of people's medicines, however people were at risk of not receiving their medicine at the times they needed it due to the lack of clear guidance and protocols for staff.

People were protected from abuse and the risk of abuse as staff knew what to do if they suspected someone had been abused. There were enough staff to keep people safe. The provider had employed new staff to improve the safety and quality of the service provided. Safe recruitment procedures were in place.

Staff felt supported and had received training to be able to fulfil their roles effectively.

People had enough to eat and drink and were supported to have their health care needs met in a timely manner by health professionals.

Staff were kind and compassionate to the people they cared for. Relatives were kept informed and were welcome to visit at anytime.

Hobbies and interests were now on offer for people to engage in. More opportunities to engage with the local community were being explored.

The provider had employed a new management team to support them to make improvements to the service. Systems were now in place to monitor and improve the quality of care being delivered to people.