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Inspection carried out on 12 December 2016

During a routine inspection

This inspection took place on 12 December 2016. Green Tree Court is registered to provide accommodation for 68 people who require nursing and personal care. The welcome brochure describes the home as “built to the highest environmental standard offering luxurious surroundings and beautiful fully landscaped gardens”. No expense has been spared to ensure care, facilities and the environment are of the highest standard for the people living there. There are three wings, Larch, Maple and Willow. Willow wing is designated for people living with dementia. At the time we visited, 44 people lived at the home, seven receiving respite care.

The service was registered with CQC in November 2014 and has not been inspected previously. Since registration, the service was increasing numbers to capacity in a managed, measured way to ensure people’s individual needs could be met.

There was a registered manager and two heads of care employed at the home who were clearly passionate about providing a high quality, individualised service. 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 and associated Regulations about how the service is run.

People had access to and were involved in developing personalised activities that complemented their individual hobbies and interests. Links with the local community had been established and people were supported to participate in community events and other events that were important and meaningful to them. For example, through the service partnership with the Exeter Dementia Action Alliance, foreign exchange students and local primary and secondary schools. This provided people with a sense of purpose and wellbeing. Some people used the service as respite for short periods before returning home to the community. This had become popular with people who used the home as a stepping stone following hospital procedures or to enable carers to have a break.

People and relatives were overwhelmingly positive about the care and service provided. The overall view was that the service was like a ‘caring holiday’. Comments included, “It’s like being on a cruise, so enjoyable”, “I can walk away knowing I couldn’t do better, it’s lovely to see the manager work so well with her team” and “There are high standards all the time, people are treated as people.” Reviews on the website included, “It is like a 5 star hotel, the service we have had has been faultless. Being a new building, the rooms are large and purpose built. Everything is fresh, airy and spotlessly clean”, “The home is excellent” and “I feel Green Tree [Court] is a luxury care home of very high standards, and I have been very impressed with the care received.” All reviews showed a five out of five star rating and people were ‘extremely likely’ to recommend the service.

People were supported by very kind, caring and compassionate staff who often went the extra mile to provide people with good, high quality care. This high standard of care enhanced people's quality of life and wellbeing. The staff as a whole, supported by the activities team, were extremely passionate about providing people with support that was based on their individual needs, goals and aspirations. They were pro-active in ensuring care was based on people's preferences and interests, seeking out activities in the wider community and helping people live a fulfilled life, individually and in groups.

The staff were happy working in the home and felt very supported in their role. They were clear about their individual roles and responsibilities and felt valued by the registered manager, heads of care and the wider provider, senior management team. Good leadership was demonstrated at all levels with pro-active effort to encourage ideas from staff to further benefit the people in their care and maintain a strong, stable staff team with a shared goal. Each individual staff member was engaged in sourcing new opportunities for people and putting ideas into practice.

People were safe living at Green Tree Court. There was a high staff ratio to ensure there were enough staff to meet people's care needs safely and also to provide individualised time and support in and out of the service. There was a strong culture within the home of treating people with respect. The staff and managers were always visible and listened to people and their relatives/friends, offered them choice and made them feel that they mattered. The registered manager said, “I’m so proud of this home. The staff are incredible and everything is about the person here.” Staff spent time with people to get to know them and their needs and this had ensured that behaviours that could be challenging for staff and distressing for people were minimised. Issues were identified and staff spent time with people to improve the quality of their lives and promote independence. People and the staff knew each other well and these relationships were valued. For example, the registered manager was supporting one person who they felt would benefit from returning to the community with support. The focus was on what was best for people individually to promote good quality living, reflected by the Lexicon Health Pledge (home’s aims and ethos) and staff comments during the inspection.

Staff had received appropriate training in line with nationally recognised qualifications and regular supervision to provide them with the necessary skills and knowledge to provide people with effective care. People received their medicines when they needed them.

The environment was outstanding. Each room was decorated and furnished to a very high standard. For example, specialist beds and furniture were bespoke, of a very high quality and designed to look as domestic and luxurious as possible. Premium rooms on the lower ground floor were quieter and included access to private garden spaces. The communal garden was landscaped with the safety and enjoyment of people living with dementia in mind, including safe, enclosed areas directing people in circular walks. Children’s play areas outside and inside encouraged people to spend time with their families. There were numerous communal spaces, lounges, quiet rooms, dining areas and a large decking balcony. People were able to move around the home freely or with support, enjoying the spaces. The service also provided a fully equipped professional beauty and holistic therapy room, nail bar, a physiotherapy gym and an activity room and professional hairdressing salon. A large, staffed reception area, café and snack station for residents and relatives, library, IT and learning area, shop and large wall fish tank made the entrance very welcoming.

People received a bespoke, nutritious diet and enough to eat and drink to meet their individual needs. The service ran a commercial kitchen, managed by a Hotel Services Manager and national award winning head chef, providing bespoke meals to an excellent, high standard with the support of a team of hosts and hostesses trained in customer care. Timely action was taken by knowledgeable staff when they were concerned about people's health and there were good links with local health professionals.

There were effective systems in place to monitor the quality and safety of the care provided. People felt able to raise any concerns and be confident they would be addressed. Where concerns were raised by people, relatives or through regular auditing we saw the home took them seriously and took appropriate actions to focus on learning and improvement for the benefit of the people using the service.