This inspection took place on 08 December 2016 and was an unannounced comprehensive rating inspection. The location was last inspected in December 2015 and was rated as ‘Requires Improvement’ overall.

Perry Tree Care Centre is located in a building where several services are based. These included an enablement unit, day services, community services and a restaurant. This inspection relates to the residential unit only where up to 32 people live with conditions relating to old age, physical disability and dementia. At the time of our inspection there were 30 people living in the residential unit.

There was a registered manager in post at the time 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 were kept safe. Staff had received training and understood the different types of abuse and knew what actions to take if they thought a person was at risk of harm. Staff were able to recognise the signs of abuse and raise concerns if needed. Staff were provided with sufficient guidance on how to support people’s medical care and support needs. People’s medicines were managed and administered safely and as prescribed.

People were supported by sufficient numbers of enough staff that had been safely recruited. People and relatives felt that staff demonstrated the appropriate skills and knowledge to provide good care and support. Staff were trained and supported so that they had the knowledge and skills they required to enable them to care for people in a way that met their individual needs and preferences.

People were encouraged to make choices and were involved in the care and support they received. Staff had an awareness of the Mental Capacity Act and Deprivation of Liberty Safeguarding (DoLS) and how to support people within their best interests. Staff were respectful of people’s diverse needs and the importance of promoting equality.

Staff were caring and treated people with dignity and respect. People’s independence was respected and promoted. Staff responded to people’s support needs in a timely manner. People and their relatives felt they could speak with the provider about their worries or concerns and were confident that they would be listened to and have their concerns addressed.

Staff spoke positively about the service provided and the supportive culture they had established at the home. The registered manager had quality assurance and audit systems in place to monitor the care and support people received. This ensured where improvements were identified action could be taken so people continued to receive a good service. During our inspection we shared with the provider the areas of improvements we had identified in the systems that could further improve the service and minimise the potential risks to people.

On the day of our inspection there were a total of 32 people living at the home. We spoke with six people and four relatives. Some people were unable to verbally share with us their views about their care. We used different ways to evidence their experiences such as observing care and speaking with relatives.

We spoke with five members of care staff, the acting head chef and the registered manager. We also sampled four sets of care records.

Care was planned and delivered to ensure people's safety and welfare. One person told us, "I am very happy with the care, I get help when I need and also get on with my own things when I want to". This meant that people experienced care and support that met their needs and protected their rights.

People's nutritional needs were assessed and monitored. People were provided with a choice of suitable food and drink to meet their nutritional needs. One person told us, "The food is very good and I can have a hot drink whenever I want".

Safeguarding procedures were in place so that staff would recognise and report any allegations of abuse so that people were protected from the risk of harm.

People were cared for by staff who were supported, supervised and trained to deliver care to an appropriate standard. One person told us, "Staff are lovely, they look after me".

Records contained relevant information about people's health and wellbeing so that people were not at risk of inappropriate or unsafe care.

On the day of our inspection there were a total of 25 people living at the home. We spoke with four people who lived at the home. Most people were able to speak with us but there were some people who were unable to verbally share with us their views about their care. We were able to look at other areas for evidence to support their experiences such as observing care and speaking with relatives.

We spoke with four members of care staff, the head chef and the registered manager. We also sampled four sets of care records.

There were four units within the home that were based on specific themes such as ’Hollywood Close’ and ‘Garden View’. Each unit had a lounge area, staff explained people had a choice and were able to sit where they pleased.

People were happy with the standard of care and people had a choice of activities available to them. We saw some evidence of good practice such as individual risk assessments and use of observation chart, however there were inconsistencies in assessments and care planning.

People we spoke with told us they enjoyed their meals and were offered a choice. We

saw during lunchtime people were given their chosen meal. Staff we spoke with were aware of people's nutritional needs. We saw evidence of nutritional needs monitoring but assessments were inconsistent and not regularly reviewed.

Staff we spoke with told us they were aware of the need to safeguard people from harm and were able to explain their role in protecting vulnerable people.

Staff we spoke with said they had appropriate training and skills to meet the needs of people. Staff demonstrated knowledge and awareness in areas relevant to the people they cared for. We saw evidence on the training matrix that there were still gaps in training.

Systems were in place to deal with comments and complaints.

We spoke with six of the people living in the home and three visitors. The people living in the home told us they were satisfied with their care and that their needs were met at the home. The people living in the home and their visitors told us the care workers were friendly and approachable. The visitors were also very happy with the service being offered at the home comments included:

‘Lovely place’

‘No complaints at all.’

‘Love it wonderful place.’

The care workers were able to tell us about the needs of the people living in the home and how they liked to be cared for. This should ensure people received their care in the way they prefer.

People told us the food at the home was ‘good’ and that they were given choices at each meal. We saw that medical and cultural diets were being catered for.

During the visit we spoke to seven of the people living in the home and four visitors.

People told us they were satisfied that their relatives and themselves were treated with respect by the staff. Visitors told us they were encouraged to be involved in the care of their relatives if they wished.

People were satisfied that they had been able to visit the home before they moved in to see what facilities it offered. One person told us they visited the home with their relative, helped choose a bedroom and were then able to set up the room to their relatives liking with personal possessions and so on.

Overall the people living in the home and the relatives we spoke with were satisfied with the care provided at the home. They told us:

“Overall they do very well”

“Love it here”

“Quite alright.”

“Get everything I need.”

“I have seen the doctor today got some medicine.”

People told us that health care professionals regularly visit the home, for example the doctor.

People that were able to express their views were satisfied that there were some activities in the home. They told us:

“Don’t get bored have T.V. and radio go into the lounge sometimes.”

“I read and do some knitting. Have a lot of visitors.”

“We go out once a week to the legion.”

“Been out today with a relative.”

One visitor told us her relative really enjoyed music and “staff will put on CDs if I ask them to.”

Another said “there is usually some activity going on, even if not all the residents want to join in.”

People told us they were offered choices at meal times and that they could choose where they ate their meals. They said:

“Quite alright do get a choice.”

“Food alright, I like Weetabix in the morning, don’t bother much after that.”

“Food marvellous come round with menu really lovely.”

“The food seems very good.”

We saw that people were comfortable and that they could spend time privately in their bedrooms if they wished. People told us:

“I have a lovely big room.”

“Everything is beautiful.”

“Alright here if you use everything.”

We received some very positive comments about the care workers including:

“Friendly staff.”

“Staff are o.k.”

“Some staff are o.k.”

“They do come if I use buzzer.”

Visitors told us:

“The staff are very caring here.”

“Staff are very approachable”

People told us they had no difficulties in approaching the senior staff if they wanted to raise any issues. They were confident they would address any issues.