Pear Tree Court

Updated 8 April 2021

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. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by two inspectors, 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.

Service and service type

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

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of the inspection the registered manager was absent from the service. A relief manager was temporarily managing the service with support from the providers operations support manager. We have referred to the relief manager as ‘the manager’ throughout the report.

Notice of inspection

We gave the service 30 minutes notice of the inspection visit as we needed to be sure the inspection could be undertaken safely.

What we did before the inspection

We reviewed information we had received about the service since the last inspection including notifications. Notifications are information about specific important events the service is legally required to send to us. We used the information the provider sent us in the provider information return. 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. We received feedback from the local authority and professionals who work with the service. We used all of this information to plan our inspection.

During the inspection

We spoke with twelve members of staff, including the quality development manager, the deputy manager, the regional relief manager, the operations support manager, two unit managers, the regional director, a volunteer, two care staff, 1 nurse and a dining assistant. We spoke to five service users (four via a video link) and one staff member and we spent time observing the support and interactions between people and staff. We also reviewed the environment and equipment in place. We reviewed a range of records. This included three staff recruitment records, governance and training records and multiple medication records on Napier and Murray units.

After the inspection

We spoke with a further five care staff members by phone. We reviewed care records for seven people. A variety of records relating to the management of the service, including policies and procedures were reviewed. We continued to seek clarification to validate evidence found.

Updated 8 April 2021

About the service

Pear Tree Court is a residential care home providing personal and nursing care to 46 people at the time of the inspection. The service can support up to 72 people. The service was purpose built and accommodation in en-suite bedrooms is arranged over three units on different floors. Gale unit provides residential care, Napier unit provides care and support for people living with dementia and Murray unit provides nursing care. Each floor has its own lounge, dining room and TV lounge. Other facilities include a café, hair salon and cinema.

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

Risks to people were not always assessed or managed safely and records relating to risk management were not always accurate or consistent. Actions were being taken to improve risk management, however the provider needs to check these are effective.

The management of people’s medicines was not always safe. We did not find any harm to people, but improvements were required in the management of controlled drugs, medicine storage, topical medicines (applied to the skin) and decision making.

We received mixed feedback about staffing levels from staff, relatives and people. The provider used a dependency tool to calculate how many staff were required to meet people’s needs and this showed enough staff were available. The provider had acted on concerns about staff deployment to use staff resources more effectively.

The manager and staff understood their responsibilities to keep people safe. Incidents including safeguarding were reviewed to ensure appropriate action were taken. The provider was acting to make improvements to the safety of care people received following concerns identified by the local authority safeguarding team.

Quality assurance systems had not always been effective in identifying the concerns we found at this inspection and bringing about improvement. We observed staff did not always treat people with dignity and respect, the manager acted on this immediately. There had been difficulties in establishing a positive culture in the staff team, we have made a recommendation about this. We received positive feedback about the new manager.

There was a limited approach to obtaining the views of staff, relatives and people who use services to show how they are involved in shaping the service. The provider told us this was because their priority had been to embed government guidance about safe working practices in relation to COVID-19. The service had received compliments and a high score on a care home review website for the care provided.

Rating at last inspection

The last rating for this service was Good (published 2 May 2019).

Why we inspected

The inspection was prompted in part due to concerns received about neglectful care and treatment, how people were protected from the risk of harm and abuse and a lack of leadership. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led only. Ratings from previous comprehensive inspections for those key questions not inspected were used in calculating the overall rating at this 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 that the service can respond to coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Pear Tree Court on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

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

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.