The Service Tree Limited

This was the first inspection of the service since it was registered at its new address. We last completed an inspection of the service in March 2016. At that inspection we said that the overall quality rating for the service was, ‘Good’. At the previous inspection the safe rating was requires improvement. At this inspection this rating had improved and was now ‘Good’.

At this inspection we found the evidence continued to support the rating of ‘Good’ and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were very satisfied with all aspects of the service provided and spoke highly of staff and the registered managers. People who used the service told us they were treated with compassion and kindness and that their privacy and dignity were respected.

People who used the service and relatives we spoke with told us they felt staff provided safe and effective care. Staff turnover was low which people and relatives valued. People were supported by a small team of staff that understood their needs.

We found that there were systems, processes and practices to safeguard people from situations in which they may experience abuse including physical harm. Risks to people’s safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected.

People told us they received their medicines as prescribed. Medicines Administration Records (MARs) reviewed had been completed by staff and were regularly audited by management.

Background checks had been completed before new care staff had been appointed. People were protected by there being arrangements to prevent and control infection and lessons had been learnt when things had gone wrong.

Staff had received all the training required to support people safely. Staff received regular supervision and annual appraisals and were able to reflect on the care and support they delivered. Staff were able to identify further training in addition to their mandatory training.

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

People had their rights protected under the Mental Capacity Act 2005. People were supported to eat and drink sufficient amounts to meet their nutritional needs when required. People had been supported to live healthier lives by being supported to have suitable access to healthcare services so that they received on-going healthcare support. Suitable arrangements had been made to obtain consent to care and treatment in line with legislation and guidance.

People received personalised care that was responsive to their needs. Care staff recognised the importance of promoting equality and diversity by supporting people to make choices about their lives. Confidential information was kept private.

There was strong sense of leadership in the service that was open and inclusive. The registered persons focused on achieving positive outcomes for people and their staff. People benefited from there being a robust professional management framework that helped care staff to understand their responsibilities so that risks and regulatory requirements were met.

The service encouraged feedback from people who used the service, relatives and care staff. Views were gathered through questionnaires, telephone conversations, regular face-to-face meetings at their home or in the office.

No complaints had been received in the last 12 months. People were introduced to lay advocates if necessary.

Quality checks had been completed to ensure people benefited from the service being able to quickly put problems right and to innovate so that people could consistently receive safe care.

The registered managers who were also the owners of the service had a clear vision of delivering high-quality person-centred care. Staff understood and were committed to realising this vision. There was a positive and open team culture, the registered managers were visible and supportive of staff. Staff and people's views about how to develop and improve the service were encouraged and acted on.

Staff and management worked in an open way with external agencies, such as the local authority and community healthcare services, to share information about people's support. This helped identify and agree how best to work in partnership, so people could receive consistently effective and person-centred support.

Further information is in the detailed findings below.

At the time of our inspection The Service Tree Limited offered support to 41 people living in Nottinghamshire mainly in the Rushcliffe area. They specialise in supporting people living with dementia.

There were two registered managers in place and both were available during the 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.

People were very satisfied with all aspects of the service provided and spoke highly of both staff and managers. People who used the service told us they were treated with compassion and kindness and that their privacy and dignity were respected.

People who used the service and relatives we spoke with told us they felt staff provided safe and effective care. Most staff we spoke to had a good understanding of the various types of abuse and their roles and responsibilities in reporting any safeguarding concerns. Staff had also received safeguarding adults training.

People’s care plans reflected their individual needs and personal wishes. People told us they were involved in the development of their care plans and were enabled to express their views on an on going basis.

Staff at the service were carefully recruited and were required to undergo a number of background checks prior to starting their employment. This helped to ensure only people with the required skills and of suitable character were employed. However, on one occasion this was not the case, as a new member of staff began to lone work before their DBS (Disclosure and Barring Service) check had come through.

People told us they received their medicines as prescribed. However, the Medicines Administration Records (MARs) we looked at had gaps where signatures were required.

Staff received regular supervisions and annual appraisals and were able to reflect on the care and support they delivered and identified further training requirements. The service encouraged feedback from all people involved with the service.

People received care and support from kind, caring and compassionate staff, who respected their privacy and dignity at all times.

People who used the service including staff, were positive about the leadership of the service. Staff were clear about the vision and values of the service.