Treetops

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question as Good. At this assessment the rating has remained Good. This meant people were safe and protected from avoidable harm.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

People were encouraged and supported to raise safety concerns with the provider. The registered manager and staff understood the importance of reporting safety concerns and learning lessons when things went wrong.

Systems were in place to support staff to report and record safety concerns and events when they arose. The registered manager investigated safety concerns and events and used the learning from these to support staff to continually improve their practice, reduce risk and keep people safe.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The provider had an appropriate process for new referrals, obtaining a copy of the person’s initial assessment, and then carrying out their own assessment of need, before deciding whether they would be able to provide support. There was an electronic and paper-based care record system in place, which care staff had access to. This helped ensure people’s care was provided in a planned, responsive and organised way.

People, and their relatives if appropriate, were listened to by the provider’s staff when their initial care plans were being created. This helped ensure people were supported to receive continuity of care when moving into the service.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People were relaxed and comfortable when staff interacted with them. Staff used respectful language when describing people and their care needs, and people appeared to be supported to dress appropriately and appeared well cared for. The provider had a comprehensive safeguarding policy and procedure in place, which included consideration of sexual safety and online safety. Staff received regular safeguarding training.

People also had access to people outside of the service with whom they could raise concerns about their safety if necessary. For example, social workers, other visiting health care professionals, and family members.

The provider carried out investigations into any incidents which occurred at the care home. They also co-operated with safeguarding enquiries carried out by the Local Authority. The provider’s investigation findings were used by the registered manager to identify any lessons learned and actions to be taken to ensure people were protected from abuse.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The care home staff did not use restrictive interventions, such as restraint, seclusion or segregation. Staff were trained to use positive behavioural support techniques to divert and distract people who were experiencing periods of distress or acute anxiety.

The provider reviewed all incidents for recurrent trends or triggers. Information was shared with the staff so support arrangements could be changed to reduce recurrences. This meant staff understood distressed behaviours communicated a person needed support in a different way.

Staff were seen to promote a supportive, consistent and predictable atmosphere in the care home. People’s individual risks were regularly assessed, and positive risk taking was used as a means of enabling people to become more independent. For example, people were encouraged to carry out domestic activities for themselves, and take part in community-based activities where appropriate. People were involved in managing their own risks where possible.

The care home had rooms within it, and extensive garden areas, where people could safely go to if they wanted time by themselves when they were distressed or acutely anxious.

The provider had CCTV cameras in communal areas, so staff could observe people’s movements if necessary to ensure their safety, while still allowing them space to be by themselves. People’s care plans evidenced they had consented to that level of surveillance, or that a best interest decision had been taken if the person lacked the mental capacity to consent to the use of CCTV in communal areas of the care home.

People’s care plans detailed how to support them when they were distressed or anxious. Staff knew the people they supported and were aware of people’s symptoms and cues which might indicate they were becoming unwell or distressed. Staff were observed to support and encourage, rather than coerce or control people.

People’s individual risks were identified and assessed in their care plans. Care plans were regularly assessed and amended when people’s needs changed or when they changed how they wanted to receive care from staff.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.People were cared for in a safe environment which had been adapted to meet their needs.

The provider’s facilities and equipment were generally well-maintained and supported staff to deliver safe and effective care. However, the care home had a lift which was not operational at the time of the inspection. This was discussed by the inspector with the registered manager. They told us the lift was not required by anyone living at the care home, and that no one who had mobility support needs used the upstairs bedrooms or facilities upstairs. The registered manager told us the provider did not intend to repair the lift for the time being, as it was not needed by the people currently living there.

The registered manager further stated the lift would be repaired by the provider if any people, who had mobility needs, were referred to the care home, and who required an upstairs bedroom. Similarly, if people currently using an upstairs bedroom developed mobility support needs, and if there was no suitable bedroom downstairs, then the provider would arrange for the lift to be reinstated.

The care home was an adapted period residence set in large, landscaped, grounds. The provider had maintenance staff employed at the care home, who ensured effective arrangements were in place to maintain the safety of the premises.

The provider had effective processes in place to monitor the safety and upkeep of the premises. The care home appeared clean and was free from unpleasant odours. People were able to personalise their individual bedrooms which helped to create a more homely atmosphere

The registered manager made sure there were enough qualified, skilled and experienced care staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The registered manager had an effective programof appropriate staff training in place, and staff were observed to put that training into practice.

Staff received specific training to ensure they could meet the needs of autistic people and people with a learning disability. This included communication needs, positive behaviour support, reducing restrictive practices, epilepsy, understanding learning disability, and interacting with autistic people.

The registered manager encouraged staff to develop their skills and knowledge, and to progress to more senior roles where appropriate. A staff member told us, “We have a great training programand in house training is brilliant and gives us a lot of knowledge and understanding of our roles.”

The registered manager ensured enough suitably trained and experienced staff were rostered on duty to meet people’s assessed care and support needs. The provider used a standardised dependency assessment tool as a guide to determining the basic numbers of staff needed on each shift, but the registered manager was able to adjust staffing levels if necessary to meet people’s changing needs.

The registered manager did not use agency care staff, and this meant people were generally supported by staff who knew them well and knew how they preferred to receive care

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

People were protected as much as possible from the risk of infection because premises and equipment were kept clean and hygienic. The provider employed cleaning staff to work at the care home.

There was an effective approach to assessing and managing the risk of infection, which was in line with current relevant national guidance. The provider had an infection prevention and control (IPC) policy and procedure in place, which staff had access to.

The provider’s IPC policy and procedures set out the clear roles and responsibilities around infection prevention and control at the care home.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

People were appropriately involved in decisions about their medicines, and their medicines were appropriately prescribed, supplied, stored, and administered in line with the relevant legislation.

People’s prescribed medicines were regularly reviewed by an external medical professional. Medicines were not used by staff to restrain or control behaviour. The provider aimed to support people to reduce their prescribed medicine when safe to do so, and in line with external expert medical advice.

The provider had appropriate arrangements in place for the safe management, use and oversight of controlled drugs. People had up-to-date information about their medicines available in their care plans and the provider’s medicine records. A person told us, “Yes, one of the staff brings me my medicines four times a day. They look after it for me.”