Archived: Treetops Residential Home

Treetops Residential Home provides accommodation and personal care for up to 24 older people. The service is a large converted property. Accommodation is arranged over three floors and a lift is available to assist people to get to the upper floors. There were 18 people living at the service at the time of our inspection.

A registered manager had not been working at the service since April 2016 and the providers were leading the service. The provider had a condition on their registration that required a registered manager to be in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run. One of the providers planned to apply to CQC to become the registered manager until a suitable manager was appointed and had completed their employment probation to the provider’s satisfaction.

Detailed plans and equipment were not in place to keep people safe in an emergency. The providers requested the local Fire and Rescue Service visit the service to give them advice and guidance following our inspection.

Detailed information was not available for staff to refer to about people’s care and how to manage risks to them. The provider had identified this before our inspection and had put plans in place to address these shortfalls. This did not impact on the care and support people received as staff knew people well and people were able to tell staff what they wanted. People’s care was planned with them, to keep them safe and help them be as independent as possible. Possible risks to people had been identified and were managed to keep them as safe as possible, while supporting them to be independent.

Some people wanted more to do during the day. The provider was recruiting an activities coordinator to offer people a wider variety of activities.

People received the medicines they needed to keep them safe and well. Changes in people’s health were identified quickly and staff contacted people’s health care professionals for support. People were encouraged to eat a balanced diet.

Staff were kind and caring to people and treated them with dignity and respect at all times. Staff knew the signs of abuse and were confident to raise any concerns they had with the providers. Complaints were investigated and responded to.

The providers had oversight of the service. Staff felt supported and were motivated. They shared the provider’s vision of a good quality service.

There were enough staff, who knew people well, to provide the support people wanted. People’s needs had been considered when deciding how many staff were required to support them at different times of the day. Staff were clear about their roles and responsibilities and worked as a team to meet people’s needs.

Checks had been completed to make sure staff were honest, trustworthy and reliable. Disclosure and Barring Service (DBS) criminal records checks had been completed. The DBS helps employers make safer recruitment decisions and helps prevent unsuitable people from working with people who use care and support services.

Staff had completed the training and development they needed to provide safe and effective care to people and held recognised qualifications in care. The providers met regularly with staff to discuss their role and practice. They supported staff to provide good quality care.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). People were not restricted and went out when they wanted to. Some people went out without staff support. Applications had been made to the supervisory body for a DoLS authorisation when necessary.

The requirements of the Mental Capacity Act 2005 (MCA) had been met. Staff supported people to make decisions and respected the decisions they made. When people lacked capacity to make a specific decision, decisions were made in people’s best interests with people who knew them well.

The providers worked alongside staff and checked that the quality of the service was to the required standard. Any shortfalls found were addressed quickly to prevent them from happening again. People, their relatives and staff were asked about their experiences of the care and their feedback was acted on.

The focus of the inspection was to follow up on the compliance actions we had set from our last visit on 7 April 2014. This report focused on two outcome areas only, the arrangements the service had to make sure people consented to their care and treatment and the safety of medicines. In our inspection, we assessed the answer to five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People were supported in an environment that was safe, clean and hygienic. There were enough staff on duty to meet the needs of the people using the service. A person said 'I feel safe here.' There were suitable arrangements for people to consent to all matters about their care and treatment. Medicine records were kept up to date and any changes made by the medical professionals were documented and action taken immediately.

Is the service effective?

People and their representatives were involved in their assessment and care planning. All care and support was planned with people's consent. Where people were thought to lack capacity to consent to decisions, and assessment had taken place. People who knew the person well were, with the person's consent, consulted too.

Is the service caring?

People's care was reviewed regularly, and adjustments were made make sure they remained comfortable, safe and as independent as possible. Any suspected change in personal capacity to consent was followed up to make sure there was no underlying health issue. We saw people being cared for in an easy going, pleasant way. People were confident to ask for help, use their call bells, call out to named staff and request drinks and snacks.

Is the service responsive?

People's day to day support was kept under close review, and any changes needed were communicated to the team. People told us the manager and team were easy to speak with. The staff team responded to people's requests with minimal delay. Staff sought help from other professionals or services quickly, meaning people remained well supported. We were told by the district nurse that the service never hesitated to seek support.

Is the service well led?

The service was able to be critical of its' own performance and evaluate what changes were needed to sustain good support for people in the future. There was a system of support for the team to access supervision and training. The manager had responded well to the concerns we raised at our last inspection and demonstrated working knowledge around supporting older people.

Some of the people that used the service had dementia and therefore not everyone was able to tell us about their experiences. However we made observations of care and some people using the service were able to tell us about their experiences and we also spoke with a visiting relative to the service.

We observed people expressing their opinions in a way that staff understood despite their communication difficulties. Staff had a good understanding of people's methods of communication and picked up on an individual's body language in order to support people in a way they preferred. Although we were unable to directly talk to all of the people who used the service, due to their communication difficulties,we observed that they were happy with the care and support being offered and that their independence was encouraged.

Relatives spoken with told us that the service responded to their relatives health needs quickly and that staff talked to them regularly about their plan of care and any changes that may be needed. People said staff were caring and treated them with respect. Relatives spoken with and observations made did not raise any concerns with regard to the quality of care received. All staff spoken with demonstrated experience and knowledge to enable them to support people who lived at the service with their needs.

The service did not have systems and procedures in place with regard to mental health assessments under the Mental Capacity Act 2005.

Some concerns were noted about the correct storage of medicines. Records viewed showed that staff had not received training updates in administering medication in line with current guidance as recommended by Skills for Care, a government training agency.

Some systems to monitor the service were in place and the provider made visits to the service daily. Surveys were regularly distributed to staff and meetings with the people who used the service were arranged where possible. However the provider may find it useful to note that quality assurance processes were in need of review to give further confidence to the provider that the required regulations were being met.

During this inspection we undertook a tour of the building and reviewed the action plan sent to us by the provider. We noted the improvements made with regard to carpeting and internal decoration and found the service to now be compliant. No further action with regard to the outstanding compliance action is planned.

We did not speak to people who used the service.

Many comments received were complimentary of the service. One lady said 'It's lovely here' another said 'I'm quite happy here. Staff treat me well'. Other people were complimentary of the food and had no concerns with regard to the quality of care.

One relative said "I'm very happy with my Mum being here. Staff are brilliant, they are very patient, and are not clock watchers".

People said that they had an active say on ways to improve their care. The manager said they were receptive to comments and concerns and strived to resolve any issues as soon as possible. People had their comments listened to and acted on. Staff were confident that people were able to express concerns if necessary.

Whilst bedrooms were generally well maintained other parts of the service were not so well maintained. General paintwork within parts of the service were faded and chipped posing a possible infection control risk as it prevented effective cleaning.