This inspection was unannounced and was undertaken on 26 January 2015.
Twelve Trees was last inspected by the Care Quality Commission (CQC) in January 2014 and was found to be meeting regulations relating to respecting and involving people who use services, care and welfare of people who use services, cleanliness and infection control, staffing and complaints.
Twelve Trees Residential Home is a large converted Victorian house which provides accommodation for up to 34 people who require nursing or personal care. There were 28 people living at Twelve Trees Residential Home at the time of this inspection, some of whom were living with dementia.
There are 26 single en-suite rooms and 4 double en-suite rooms. Accommodation is provided over three floors, accessed by a lift. Shared, adapted bathrooms are situated throughout the home. The home has two lounges and two dining rooms.
A registered manager 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.
People told us that they felt safe living at Twelve Trees Residential Care Home. We found that there were sufficient staff to meet people’s needs and keep people safe. Conversations with staff and the registered manager demonstrated that they were aware of local safeguarding procedures and had the necessary knowledge to ensure that vulnerable adults were safeguarded from abuse.
People told us that they received their medicines on time. Our observation of part of one of the medication rounds together with our review of records provided evidence that medicines were safely administered, recorded and stored.
There were sufficient care staff to meet people’s needs. Staff were aware of people’s nutritional needs and food preferences. Our informal observations of mealtimes, conversation with the cook and our review of nutritional records evidenced that people received a choice of suitable, healthy, homemade food and drink.
Conversations with staff and observations throughout our visit showed us that staff offered and involved people in a range of day to day decisions. The registered manager demonstrated a clear understanding of the requirements of the Mental Capacity Act, 2005 (MCA). Whilst our observations evidenced that staff followed the principles of the MCA, our conversations with staff demonstrated a lack of knowledge about the important elements of the actual Act and how these related to their practice. For example, whilst staff told us that they had heard of capacity assessments and best interest decisions, they were unable to explain these key parts of the Act.
There was a lack of appropriate directional signage in some areas of the home to orientate and support people living with dementia to locate key areas of the home.
Staff received regular supervision and an annual appraisal. Staff were positive about the training courses they received and the further training courses they were encouraged to undertake. We found that some staff had not received courses relevant to the needs of people who used the service for a number of years. For example, some staff had not received dementia training since 2008 and 2009.
Our observations together with conversations with people, health professionals and relative provided evidence that the service was caring. We saw that staff across the home had a good understanding of people’s individual needs and preferences. Staff knew how to respect people’s privacy and dignity.
People’s physical health needs were monitored and referrals were made when needed to health professionals. The registered manager and staff spoken with during our inspection were proud of the end of life care they provided to people. This was further demonstrated by our conversation with the home’s GP who describe end of life care the home provided as, “Excellent.”
The home was proactive in providing activities and experiences to meet people’s differing needs and preferences. People were supported to continue to attend the groups and clubs they enjoyed prior to living at the home and to maintain existing community links.
Staff were positive about the registered manager and the way in which she led the service. They told us that the registered manager was always around and was approachable and proactive in trying to make the service as good as possible.
A range of regular scheduled and unscheduled checks were undertaken to monitor the quality of the service. People, their friends and family and visiting health professionals were encouraged to give feedback about the service.