Archived: Treehaven Bungalows

Treehaven Bungalows is a care home providing personal care and support to people with a learning disability and /or autistic people. The service can support up to 11 people. At the time of inspection there were 10 people living in the home. Treehaven Bungalows is two conjoined bungalows with a majority of the accommodation downstairs, and each bungalow has an upstairs flat.

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

Safeguarding incidents were not always reported to the relevant authorities, and systems to monitor accidents and incidents was poor and lacked comprehensive oversight. Health and safety audits failed to address concerns found within the environment.

There was a lack of effective governance systems in place to monitor and assess the quality of service being delivered. The provider did not maintain oversight of how the service was being delivered. Relatives had not been asked to provide feedback about how they thought the service had been run for a number of years.

Risks in relation to people’s health and wellbeing had been identified and planned for and people were cared for by staff who understood their care needs well. There were safe systems in place around the administration and management of medicines, and staff had received training in relation to this.

People’s relatives and staff spoke positively about how the service was run by the registered manager. People’s relatives were complementary about how their family members were cared for and how they were supported to achieve good outcomes. Staff felt supported in their roles and felt able to put forward ideas about how to improve the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of the key questions of safe and well-led, the service showed how they were meeting some of the principles of Right support, right care, right culture. Based on our findings, the provider did not take adequate steps to report and investigate safeguarding concerns. Our observations and conversations with people’s relatives and staff assured us care was delivered in a person-centred way.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 25 March 2019).

Why we inspected

This was a focused inspection to check on a specific concern we had about the provider’s governance systems and oversight of the service.

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 COVID-19 and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. 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 Treehaven Bungalows 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safeguarding service users from abuse and improper treatment and good 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.

¿ Treehaven Bungalows provides accommodation with personal care for up to eleven people living with autistic spectrum disorders and/or learning disabilities. The premises consists of two bungalows and each provides four ground floor bedrooms and a self contained flat.

People’s experience of using this service:

¿ Areas of the service looked tired and some furnishings and fittings were damaged and in need of redecoration or repair. For example, carpets on the stairs were coming away from the steps and the veneer on some kitchen cupboards was peeling off. There was no dedicated maintenance person, since the last one left and maintenance has been carried out by an external contractor. This meant that small jobs were either not completed or there were long delays in responding to needs.

¿ The registered manager told us that the redecoration and replacement of furnishings was included in the providers annual development plan. However, although this included plans to create a sensory room, renovation of the previous horticulture area and a new laundry area to be developed, there was no plans recorded to re-decorate and refurbish the service. Following the inspection we were sent a maintenance list that showed areas that needed to be addressed and we saw that some improvements had been completed.

¿ The registered manager told us they had secured a regular company to provide the maintenance of the service and we saw that some redecoration had taken place. We were told this would extend to the whole service.

¿ People continued to feel safe living at the service. Risks to people’s health, safety and welfare had been identified and were known by staff. Risk assessments relating to the environment were in place to keep people safe. Staffing levels were appropriate to meet the needs of the people using the service. People told us they thought the home was well-staffed. Medicines were safely managed. The home was clean and hygienic, although some areas were difficult to keep clean because they were damaged, for example, holes in the flooring of the kitchen. There were systems in place to monitor incidents and accidents and learn from these.

¿ People’s care, health and cultural needs were identified so staff could meet these. The staff were skilled and competent and knew the people they supported well. People said they liked the food served and had a choice of different dishes. People were supported to maintain good health and referred to health professionals when required. Staff worked within the principles of the Mental Capacity Act (MCA) 2005 and ensured people consented to their care.

¿ People continued to receive care from staff who were kind and caring. People were encouraged to make decisions about how their care was provided and their privacy and dignity were protected and promoted. People had developed positive relationships with staff who had a good understanding of their needs and preferences.

¿ People received person centred care that met their needs. Care plans were written from the perspective of the person using the service and set out how staff should meet their needs. The staff team were knowledgeable about people’s needs. Managers and staff ensured information was provided to people in an accessible format. People took part in a range of group and one-to-one activities depending on their preferences. People said they knew how to make a complaint if needed.

¿ People, relatives and staff told us the service as well managed and had an open and friendly culture. Staff said the service had a family atmosphere and they felt well-supported. The providers audit system covered all aspects of the service and helped to ensure the care people received was safe and the environment fit for purpose and well-maintained. Managers and staff worked in partnership with other agencies to ensure people got the care and support they needed.

More information is in Detailed Findings below:

Rating at last inspection: Good (report published 15 June 2016)

Why we inspected:

This was a planned inspection based on the rating at the last inspection. At our last inspection we rated the service Good. At this inspection we found the effective domain had changed to requires improvement. The overall rating for this service remains Good.

Follow up:

We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

People were safe and lived in a safe environment because there were enough well trained staff to support people and appropriate recruitment checks were carried out before staff began working in the home. Identified risks to people’s safety and wellbeing were recorded on an individual basis. There was clear and detailed guidance for staff to be able to know how to support people safely and effectively.

Medicines were managed, stored and administered safely in the home and people received their medicines as prescribed.

People were supported effectively by staff who were skilled and knowledgeable in their work. All new members of staff completed a full induction and staff were supported well by their seniors, the manager and the deputy of administration.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and to report on what we find. These safeguards protect the rights of adults using the services by ensuring that, if there are restrictions on their freedom and liberty, these are assessed by professionals who are trained to assess whether the restriction is needed. Appropriate DoLS applications had been made for all 10 people currently living in Treehaven Bungalows.

People were supported to eat and drink sufficient amounts and, when necessary, people’s intake of food and drinks was monitored and recorded. Prompt action and timely referrals were made to relevant healthcare professionals when any needs or concerns were identified.

Staff in the home were caring and attentive. People were consistently treated with respect and staff preserved people’s dignity. People were encouraged and supported to be as independent as possible and their relatives were welcome to visit them. People were also supported to undertake activities or hobbies of their choice.

Detailed assessments were completed prior to admission, to ensure people’s needs could be met. These assessments were also reviewed and updated on a regular, on-going basis. People were involved as much as possible in planning their care and received care and support that was individual to their needs. Risk assessments detailed what action was required or had been carried out to remove or minimise identified risks.

People were supported to raise concerns or make a complaint if needed. Concerns were listened to, with appropriate responses, and remedial action was taken where possible.

The service was being well run and people’s needs were being met appropriately. The manager and deputy of administration were approachable and open to discussion. Communication between the staff, management and people living in the home was frequent and effective. However, some staff said they would appreciate more direct communication and updates from the provider regarding the service. To try and address this issue, the provider had appointed an employee relations officer at the beginning of 2016. In addition, a staff representative had also been elected for the service.

There were a number of effective systems in place in order to ensure the quality of the service provided was regularly monitored. Regular audits were carried out by the manager and the provider’s compliance manager. These identified areas that needed improvement and appropriate action was taken to do so.

Two people we spoke with told us that they were happy living in this home and both said that they liked the rooms they had. One person showed us how they had decorated and furnished their room with posters of their choosing and expressed their pleasure with this.

Staff we spoke with explained that various methods were used to help people make informed choices about what to eat and drink. The menu book showed that there were always at least two choices of main meal and we saw that photographs of the daily meal options were placed on a noticeboard, together with the written description.

Overall, medication was handled appropriately and there were effective arrangements in place to record the administration of medication.

Six members of staff said that they were happy in their work and felt confident in the work they carried out.

Minutes from team meetings showed that staff had opportunities to discuss all aspects of their work as well as any concerns or issues.

People living in the home were regularly supported to make their views known during meetings and one-to-one time with staff.