Livability Treetops is registered for accommodation for persons who require nursing or personal care, diagnostics and screening and treatment of disease disorder or injury. Livability Treetops provides a high dependency service and nursing care for up to 21 people who have a physical disability and may have a learning disability or an acquired brain injury. There were 17 people living in Livability Treetops on the day of our inspection.

Livability Treetops is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Livability Treetops provides people with a spacious single room with ensuite facilities in a purpose built building in a residential area in Colchester.

There was a registered manager in post who has managed the service for many years and was present on the day of our inspection. 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.

At our last inspection of the service in May 2016, we rated the service as ‘Good.’ At this inspection, we found that the service had not sustained its good rating and further work was needed to improve medicines management and governance.

People and their relatives spoke highly of the service and the quality of care provided. We found areas of good practice but there was a lack of consistency across the service. Medicines records were not clear and did not always follow the organisations own policy. These shortfalls placed people at risk of not receiving the correct medicines. Checks had been undertaken on equipment to ensure that it was safe to use however we found that one piece of equipment, which was in regular use had been missed off the safety and cleaning checks, which indicated that the system was not as robust as it should be.

Risk assessments were in place and the organisation had already identified that moving and handling assessments needed strengthening and they had a plan to address this.

There were sufficient numbers of staff available to meet people’s needs when we inspected. However, the service had a significant number of vacancies and was dependent on agency staff. The service was actively recruiting to the vacancies and there were clear systems in place to recruit staff to ensure that they were suitable for the role. New staff received induction and training to provide them with the skills and knowledge they needed to support the people living in the service.

People's nutritional needs were assessed and met. Professional advice and support was obtained for people where risks such as choking, swallowing difficulties and inadequate food and fluid intake. People were supported to access health services when they needed to.

The management team and staff understood their roles and responsibilities in relation to the to the requirements of the Mental Capacity Act 2005 (MCA) and related Deprivation of Liberty Safeguards (DoLS). 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 were motivated and supported. They were clear about their responsibilities and we observed kind and caring interactions. There was a strong emphasis on helping people to communicate effectively and people told us that they were consulted and had a say in how they were supported.

Care plans were detailed and informative and were regularly updated to reflect changes in people’s needs. They focused on people’s strengths and provided staff with guidance on promoting independence

This inspection to Treetops took place on the 24 May 2016 and was unannounced.

Treetops is registered for accommodation for persons who require nursing or personal care, diagnostics and screening and treatment of disease disorder or injury. Treetops provides a high dependency service and nursing care for up to 21 people who have a physical disability and may have a learning disability or an acquired brain injury. There were 20 people living in Treetops on the day of our inspection. Treetops is also registered to provide personal care to people in their own homes. At the time of this inspection Treetops was not providing this service, nor had it done so since its registration. We spoke to the manager about making an application to have the location removed from the registration of the service.

There was a registered manager in post on the day of our inspection. 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 and their relatives spoke positively about the care provided. Relatives told us that they had good relationships with staff and they were kept up to date with any changes in their relative’s needs.

Risks were identified and there were clear plans in place as to how they should be managed. There were arrangements in place for emergencies and on call arrangements outside office hours.

There were sufficient numbers of experienced staff to meet the needs of people who lived in the service. While there was some agency use efforts were made to reduce the impact on individuals by using consistent staff. There were robust systems in place to recruit staff to ensure that they were suitable for the role. New staff received induction and training to provide them with the skills and knowledge they needed to support the people living in the service.

People’s health was promoted and they were supported to access healthcare. People had complex needs and staff were alert to changes and signs of deterioration. The management of the service maintained good relationships with health care professionals and sought their advice appropriately.

Staff were kind and caring and committed to provide good care. Care plans were detailed and informative and were updated to reflect changes in people’s needs. Opportunities were provided to support people to have a say in how they were supported and access the local community.

There was clear visible leadership and staff were clear about their responsibilities. Staff were motivated and supported. The provider had systems in place to audit the quality of the care and drive improvement.

We found that staff had good understanding of people's individual needs. We saw that people were treated respectfully, their individuality and diversity understood. The interaction we saw between staff and people was friendly and relaxed.

Staff we spoke with said they had been properly recruited and trained. Staff told us that they received very good support in their roles.

People had the opportunity to enjoy a range of activities and, mostly with staff support, were able to get out and about in the local community.

We saw that people’s care and support was planned and reviewed regularly. Risks to the health, welfare and safety of the person were identified and managed.

Some of the people we met at our inspection could not, because of their disabilities, tell us verbally about their experiences and so we used observation to help us understand their experience of the service. People we were able to speak with told us that they were satisfied with how they were treated, with the level of support provided and with the facilities and activities available. One person told us, "I like the staff and it’s a good place here at Treetops.” Another person told us that, “The food is good, I get plenty to eat and the staff are hardworking, I have two keyworkers and they are both nice.” One person said, “My room is fine for me, staff keep it clean and I choose what things I want to have in my room.”

We were unable to speak with most people living at Treetops as a result of their limited verbal communication or limited cognitive ability. We spent time listening to and observing everyday life at the service to help us to understand what it was like for people living there. Two people told us that they were very happy living at Treetops.

We saw that Treetops provided a calm and homely environment and people were relaxed and comfortable. Staff were friendly and respectful in their approach and interacted with people using the service in a confident and considerate manner. During the course of our visit we saw that people were supported to express their views and choices by whatever means they were able to and staff clearly understood each person’s way of communicating their needs.

We found that staff were appropriately trained and sufficiently supported to deliver care and support safely. The quality and safety of the service was regularly assessed and monitored to ensure the health, safety and welfare of people using the service and make improvements where necessary.