Green Tree Court

Updated 26 February 2020

The inspection:

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team:

The inspection team over two days consisted of one inspector, a specialist advisor (for general nursing care), an assistant inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service, in this case, care services for older people.

Service and service type: Green Tree Court is a care home with nursing. People in care homes receive accommodation and personal care. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager, registered with CQC. This means that they and the provider will be legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection:

This inspection was unannounced and started early in the morning on the first day as we wanted to meet the night staff and observe the morning handover between staff shifts. This helped us to see how duties were allocated for the day.

What we did:

Prior to the inspection we reviewed the information we held about the service and the notifications we had received. A notification is information about important events, which the service is required by law to send us. We contacted the local NHS trust who are involved in some funding and carrying out assessments of people at the service, and the local authority quality improvement team for their feedback. We used the information the provider sent us in the Provider Information Return (PIR). This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.

During the inspection we spoke with fourteen people living at the service, the registered manager, head of care, head of dementia care, three family members, the chef, head of the housekeeping department, a member of the laundry team, observed a host and hostess staff meeting and general daily meeting, sat in on a nursing staff handover, and spoke with nine care and support staff.

We spent two periods of time throughout the inspection conducting a short observational framework for inspection (SOFI) on the dementia unit. This included an observation over a mealtime. SOFI is a way of observing care to help us understand the experiences of people who could not tell us verbally about their life at Green Tree Court.

We looked at the care records for six people in detail and sampled other records, such as those for medicines administration, audits and the management of risks. We looked at three staff recruitment files, sampled policies and procedures in use, and reviewed complaints, concerns and notifications sent to us about the service.

Following the inspection, the registered manager sent us additional information about the service.

Updated 26 February 2020

About the service:

Green Tree Court is a care home with nursing and is registered to provide accommodation and support for a maximum of 68 people. The service is divided into three units, Larch, Willow and Maple. Willow is designed for people living with dementia, while the other units provide for general nursing care. Both units provide long term and respite care. At the time of our inspection there were 49 people living across the three units.

Green Tree Court is a purpose-built service, registered with CQC in 2014.

People’s experience of using this service:

We identified some concerns over medicines practice. These included staff carrying out medicines practice that was not in accordance with their medicines policy, and a staff member using one person’s prescribed thickening agent to thicken another person’s drink. We also found instances where some medicines were not being clearly evaluated for their effectiveness, for example in reducing pain. No-one was harmed by these concerns, and the service’s management took immediate action to resolve them.

On the inspection, although we found staff were caring towards people, and had in many instances gone ‘above and beyond’ what would have been expected to support them, we also found some communication was not always supportive of people’s well-being. This was discussed with the management team, who took immediate action. In other instances, we saw people received positive and enhancing support from dedicated, motivated and compassionate staff.

Green Tree Court has won several high-level awards since their registration, including Care Home of the year 2018 in the National Care Awards. People living at Green Tree Court experienced a high quality environment, that was purpose built, and had been awarded a Gold Standard from Stirling University for their environment for people living with dementia. The dementia unit was calm, happy and uplifting, despite there being people there who had previously shown distressed or anxious behaviours. People had space to walk purposefully without feeling constrained or confined, and the peaceful environment contributed to their well-being. A children’s playground had been provided to encourage children to visit. The building had been designed with an awareness of their impact on the environment.

The registered manager said they wanted the service to feel ‘like a five-star hotel’, which people said was being achieved. The service had a spa, library, gymnasium, and fine dining restaurants. Rooms and communal areas were very well furnished, clean and spacious, with areas where people could help themselves to drinks, fruit and pastries throughout the day. In house therapy teams could demonstrate how they supported people’s health and well-being to improve. People’s meals were of a high quality, with restaurant style dining, or more homely presentation as people wanted.

There was an established management team at the service, with unit heads who worked alongside care staff each day. Quality assurance systems and regular audits were in place to assess, monitor and improve the quality and safety of the service provided. Effective communication systems were in place, from director level to all staff. The service was participating in research projects to help better understand and deliver exceptional care and support to people.

Risks to people from living with long term health conditions were assessed. These included risks such as from falls, poor nutrition or pressure ulcers, and included actions taken to mitigate risks where possible. People were supported and encouraged to take risks, and remain in control of their lives, supported by thoughtful and reflective practice.

Systems were in place to safeguard people from abuse, and the service responded quickly to any concerns or complaints about people’s wellbeing. Where people did not wish to follow plans to reduce risks this was clearly documented. The service learned from incidents to prevent a re-occurrence. People’s rights were being respected, and decisions had been made and recorded in people’s best interests where they were not able to make these decisions themselves. The service respected and supported individual people’s equality and diversity.

Systems for staff recruitment helped ensure potential staff were safe to work with people who may be vulnerable. High levels of staffing were in place, and this was kept under review. These and systems to ensure housekeeping staff were always available, ensured care staff were available to support people’s care needs at all times. Staff received the training and support they needed to carry out their role, including bespoke training to meet specific or complex needs.

Care plans were based on assessments of people’s needs. They contained details about people’s wishes and guided staff on how the person’s care should be delivered. We found some documentation needed minor clarification or updating, which was discussed with the head of care and nursing staff. We saw people’s care plans were being followed in practice. Staff knew people well. They understood how to support people’s communication or interpret their behaviours.

Staff told us Green Tree Court was a positive place to work, and they were well supported by the management team, who were always available or on call. Staff were very positive about working at the service, and the support they received. People were supported to continue links with the local community, and local children attended the service to be supported with their reading, or for younger children to play and interact with people living there. The service was involving people in charity fundraising. Other activities were person centred, and the service had a positive and busy atmosphere.

More information is in the full report

Rating at last inspection:

At their last inspection in December 2016 the service was rated as outstanding for the four key questions of responsive, effective, caring and well led, and good for the key question of safe.

Why we inspected: This inspection was scheduled for follow up based on the last report rating.

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.