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Inspection carried out on 26 February 2019

During a routine inspection

About the service:

¿ 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 inspe

Inspection carried out on 22 April 2016

During a routine inspection

Treehaven Bungalows is registered to provide accommodation and care for a maximum of 11 adults who have autism and/or learning disabilities. At the time of our inspection there were 10 people living in the home.

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.

Inspection carried out on 27 November 2013

During a routine inspection

We were only able to directly communicate with some of the people living in Treehaven Bungalows but we observed the care and support being provided for others and our findings demonstrated that staff supported people with encouragement and reassurance.

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.

Inspection carried out on 29 August 2012

During a routine inspection

We met and spoke with one person during our inspection and observed two other people

while they were spending time in the lounge and dining room.

Our observations of all three people showed them to appear comfortable, settled and content. We saw that staff regularly interacted respectfully with people, treated them with dignity and included them in conversations.

The person we spoke with showed us their daily timetable and responded with positive gestures, smiling and nodding, when we asked if they were happy in Treehaven Bungalows.

The person also showed us what they had chosen for their lunch that day and indicated that they had enjoyed it.

The person we spoke with told us, by showing us their daily timetable, that they were going shopping after lunch and they indicated that they were looking forward to this.

The person we spoke with responded positively when we asked if the staff supported them well.

We noted that, when talking about the staff, the person smiled and nodded a lot and frequently made positive gestures.

Inspection carried out on 17 June 2011

During a routine inspection

Two of the staff members with whom we spoke told us that all the support plans are completely person centred and that it is very important that all the staff know how each person wants and needs to be supported and what their personal routines are.

Staff told us that communication is very good between the staff and that there are good handovers, comprehensive daily notes and relevant information about people living in Treehaven Bungalows is shared appropriately at all times.

A number of staff commented that lots of things have very much improved over the last few months.

The staff with whom we spoke all told us that they have either started or completed a full induction process and one person said the induction is good because "�it makes you search for more if you don't know the answers�" We were told that the induction includes a lot of information about safeguarding as well as actual training in adult protection and abuse awareness.

When asked whether restraint was ever used, staff told us that they have received training in NAPPI (Non Aggressive Psychological and Physical Intervention) and PMA (Prevention and Management of Aggression) and breakaway techniques.

A new member of staff told how they had recently observed a more experienced carer spend twenty minutes very quietly and calmly de-escalating a potentially volatile situation by using non-physical 'diversion' techniques.

Another member of staff told us that 'safe-holding moves' are occasionally required - if out in the community for example and a person's safety is at risk - perhaps with a busy road, but any such incidents are always fully recorded on the relevant accident and incident reporting sheets.

When we asked the staff what they would do if they ever saw something they thought was wrong everybody told us that they would report it immediately. One person said: "�the organisation is very strict and will not tolerate any form of abuse�" Another person told us how they had 'whistle-blown' in the past. They told us how they had been very well supported by the organisation and that they would have no hesitation doing the same thing again should the need ever arise.

Staff members with whom we spoke told us that the management team always have an open door policy and any issues or concerns can be raised and discussed at any time.

Reports under our old system of regulation (including those from before CQC was created)