Ball Tree Croft provides care and support for up to 20 people with dementia, learning, sensory and physical disabilities. The service was divided to provide respite care for four people and permanent accommodation for up to 16 people. The premises were arranged in three adjoining units each with a self-contained kitchen, lounge and dining area. The units were accessible to people and staff through an open courtyard with a sheltered roof that protected people against poor weather.

At the last inspection, the service was rated ‘Good’. We carried out this unannounced comprehensive inspection of the service on 27 June 2017. At this inspection, we found that the service had maintained its 'Good' rating.

At our previous inspection of April 2015, we found that staff did not monitor and record people’s weights regularly and the action they took after they had received guidance from healthcare professionals.

At this inspection of 27 June 2017, we found that staff monitored and maintained detailed records on people’s weight management. Staff recorded guidance received from healthcare professionals in people’s care and support plans and daily observation records indicated they followed this. People received support with their nutrition and hydration needs and to adopt a healthy lifestyle.

People continued to receive the support they required to maintain their safety and well-being. Appropriate recruitment procedures followed at the service ensured people received care from suitable staff. People had their care delivered by a sufficient number of staff appropriate to their needs.

People remained safe from the risk of abuse because staff knew how to identify and report any concerns. Staff followed safeguarding policies and procedures to keep people safe.

Staff identified risks to people’s health and well-being and had sufficient information about how to provide safe care.

People received the support they required to take their prescribed medicines safely. Trained and competent staff managed and administered people’s medicines in line with the provider’s procedures.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff involved people in making decisions about their care and supported them in line with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People received effective care because staff received supervisions, attended training and had the support they needed in their roles. People had their health and social care needs met.

Staff understood people's needs and preferences which enabled them to develop good relationships with them. People received care that was kind, caring and compassionate. Staff encouraged people to make decisions about how they wished to have their care provided. People had care that upheld their privacy and dignity.

Staff continued to provide care that was responsive to people’s individual needs. People enjoyed taking part in activities of their choice. People gave feedback on their views about the service and the registered manager acted on them. People knew how to make a complaint if they were unhappy with their care.

People and staff commented positively about the management of the service and stated that they found the registered manager to be supportive and approachable. There was an open and positive culture at the service that focused on people’s individual needs. Appropriate systems of audits on the quality and safety of the service identified shortfalls. Action plans put in place ensured the registered manager and provider addressed concerns identified in a timely manner.

During our visit to Ball Tree Croft we spoke with the manager, members of staff, five of the people and one of their relatives.

We found that arrangements were in place for ensuring that people were asked for their consent in relation to their care and treatment. Relatives told us that they were always informed and asked for their consent prior to any change in the care of their family member.

We spoke with people and they told us; “I am very happy here”, “staff help me a lot”, “thumbs up”, “I enjoy going to my judo class”, “food is good here”, and they "enjoyed the Halloween party”. We found that there were good interactions between staff and people using the service. Staff were knowledgeable about the needs of individual people and they would support them in a respectful manner.

We found that the premises were fit for purpose, well equipped to meet people's individual need as well as securely enclosed. Most people had access to the digital lock on the main gate. We found that there were thorough recruitment processes in place for staff. We were told by the manager that they were in the process of recruiting some more permanent staff due to some existing vacancies.

Some of the people we spoke with told us that they were aware of the process of raising any concern that they may have. We found a pictorial leaflet titled, “If you have a complaint” displayed in the reception area. The leaflet gave clear guidance on how people could raise a concern.

We spoke with four people who lived at Ball Tree Croft. All of the people we spoke with were happy living there and satisfied with the support provided. People described it as "Very nice" and "In good order." One person said, "I enjoy it." Another person said, "Everybody is friends." People said that staff were nice to them and helpful. We found that people were treated with dignity and respect. People's individuality and choices were respected by staff on a daily basis.

People's support was planned and delivered in line with their assessed needs and preferences. People and their relatives were involved in care planning. The manager regularly reviewed and updated people's care records to ensure they were accurate and fit for purpose.

People told us that Ball Tree Croft was a safe place to live. We found that people were safeguarded against the risk of abuse and neglect because staff understood how to identify and report concerns. The provider responded appropriately to complaints and safeguarding concerns.

Staff had received appropriate training and support to ensure they carried out their roles effectively. Members of staff felt supported in their roles.

There were appropriate systems in place to assess the quality of the home and respond to any concerns.

The inspection took place on 21 and 23 April 2015 and was unannounced.

Ball Tree Croft is registered to accommodate up to 20 people with a learning disability and additional needs such as physical disability, sensory impairment or autism. The service provides permanent accommodation for up to 16 people and temporary accommodation, in the form of short breaks or respite, for up to four people. The premises are arranged in three adjoining units: Appletrees and Primrose provide permanent accommodation for up to eight people in each unit and Bluebell provides temporary accommodation for up to four people. At the time of our inspection, there were 15 people who lived at the service. Numbers at Bluebell varied and were usually between two to four according to the number of people booked in on any particular night. There was a regular client group of between 25 and 30 people who used this respite service at various times during the year.

Appletrees, Primrose and Bluebell form three sides to a central open, courtyard area which is accessible to people. There are flowerbeds and seating areas for people to enjoy in a safe environment. Each unit has a separate communal sitting and dining area, with kitchen adjoining. People have their own rooms which are personalised and decorated to their own preferences at Appletrees and Primrose. Rooms at Bluebell are not personalised since the client group changes frequently. However, the accommodation at Bluebell is extremely spacious with overhead tracking to assist staff to transfer people safely. Each bedroom has a large ensuite wet room which is equipped with showering facilities, toilet and washbasin.

The service has a registered manager. 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 2008 and associated Regulations about how the service is run.

People were protected from the risk of harm and staff had been trained in safeguarding adults at risk. They knew what action to take if they suspected abuse was taking place. Risks had been identified and assessed for people and were reviewed at least twice a year to ensure people’s most up to date care needs were being met. Staffing levels were satisfactory and there were sufficient numbers of staff to meet people’s needs safely. The service followed safe recruitment practices when employing new staff. Medicines were ordered, administered, stored and managed safely. Where staff were required to administer medicines, they had been trained appropriately.

Staff had the knowledge and skills they need to provide people with effective care. They had been trained in a range of essential areas such as moving and handling, safeguarding and fire safety. Regular updates to training were in place. New staff followed an induction programme and shadowed experienced staff. Consent to care and treatment was sought in line with the requirements of the Mental Capacity Act (MCA) 2005 and staff understood the requirements of this. Where people’s freedom was restricted, the registered manager had applied for authorisation under the Deprivation of Liberty Safeguards (DoLS). The majority of people were supported to eat and drink sufficient quantities to maintain a balanced diet. However, care records showed that some people had not been weighed regularly, although the registered manager had sought advice and support from relevant healthcare professionals. People were supported to maintain good health and had access to healthcare staff from a neighbouring GPs’ practice.

People received care from kind and friendly staff. Staff knew people well, their likes and dislikes and how they wanted to be cared for. People were supported to express their views and to make day to day decisions and choices. Different types of communication were utilised by staff to ensure they could communicate with people in a way that suited them. People were treated with dignity and respect by staff who were sensitive to their needs.

Care was delivered to people in a personalised way and care records provided staff with detailed information about people’s individual needs. People were encouraged to engage in community activities or to attend day centres, if they chose. Some people preferred to stay at home. Relatives and friends were encouraged to visit. Complaints were listened to and dealt with effectively in line with the local authority’s policy and procedures.

People were involved in developing the service and had devised questions which were used at interview for new staff. Residents’ meetings were held and people were encouraged to be involved in planning the garden and the organisation of activities and visits. Newsletters were circulated to people, their families and carers. Relatives were asked to express their views about the quality of the service. Staff expressed their views and contributed to the development of the service through team days. There were robust auditing systems in place to measure the quality of the care and service delivered.