We inspected Plane Tree Court on 12 July 2017, which was unannounced. At the last inspection in August 2014, the service was rated Good. At this inspection we found the service needed to make some improvements to the staffing levels, but the overall rating remained as Good.

Plane Tree Court is registered to provide accommodation and nursing care for up to 66 people, which was split across three floors. People who used the service have physical health and/or mental health needs, such as dementia. At the time of the inspection there were 61 people using the service.

There was not a registered manager at the 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 2008 and associated Regulations about how the service is run. There was a manager who had been in post for four months and we were told that they were in the process of applying to become the registered manager.

We found there were some improvements needed to ensure there were enough staff available across the service to provide support to people.

We found that people were consistently protected from the risk of harm and received their medicines safely. The provider had safe recruitment procedures in place to ensure that staff were of a good character and suitable to support people who used the service.

People continued to be supported to make decisions about their care and staff sought people’s consent before they carried out support. 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.

People’s nutritional needs were managed and monitored. Staff received training to enable them to support people effectively. People had access to health care services and advice sought was followed by staff to ensure people’s health and wellbeing was maintained.

People were treated with dignity and staff were caring and kind. People’s dignity was respected and their right to privacy was upheld. Staff promoted people’s choices by ensuring that individual methods of communication were used to gain people’s views.

People had the opportunity to be involved in hobbies and interests. People and their relatives were involved in the planning and review of their care. Staff knew people well and people were supported in line with their preferences. People understood how to complain if they needed to and complaints were managed in line with the provider’s policy.

Effective systems were in place to assess and monitor the quality of the service people received. People and staff were encouraged to provide feedback about the service and how improvements could be made. The manager was approachable to both people and staff.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014.

We last visited the service on 30 September 2013 and found that there were no breaches in regulation.

Plane Tree Court is a care home registered to provide the regulated activities: accommodation for persons who require personal or nursing care, treatment of disease disorder or injury and diagnostic or screening services. Accommodation was provided for 66 people spread over three floors. All bedrooms have en-suite facilities. The home is set in large grounds which are well maintained.

At the time of this inspection visit the manager in post was not registered with the Care Quality Commission (CQC). However evidence was seen that the applicationfor registration had been submitted and processed by CQC. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

The manager was aware of their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager was also aware of the recent Supreme court ruling in relation to DoLS. The Deprivation of Liberty Safeguards aim to make sure that people in care homes are looked after in a way that does not inappropriately restrict their freedom.

There were systems in place designed to keep people safe such as safeguarding policies and procedures and risk assessments in relation to falls, moving and handling and nutrition. We spoke with staff and found they had a good understanding of safeguarding and whistleblowing procedures which are designed to keep people safe.

We saw there were positive interactions between the staff and the people they cared for. We saw there was a good rapport and staff treated people with kindness and compassion. We saw that staff were patient and caring and gave encouragement when supporting people.

People spoke positively about the activity coordinator and the range of activities available within the home.

We found the home was clean, hygienic and well maintained and staff had access to personal protective clothing such as aprons and gloves.

There was a complaints procedure in place and people told us they knew how to complain and would raise concerns with staff or the manager. There was also a comments box in the reception area for people to post comments or suggestions if they wished.

We carried out this inspection to check whether improvements had been made since our last inspection on 8 May 2013 when we had some concerns about record keeping and how staff ensured that people were able to give informed consent about their care and treatment. Following the inspection on 8 May 2013 we were sent an action plan detailing how the areas of concern would be addressed.

During this inspection we looked at a sample of care plans and, we looked at the systems in place to evidence that people had given their consent to care and treatment. We found improvements had been made since the last inspection.

We looked at the systems in place to assess and monitor the quality of the service being delivered. We found that the action plan we had been sent following the last inspection had been implemented.

Also due to some concerns we had received since the last inspection we looked at the complaints procedure, which included the complaint log and investigation process. We found that it was clear and was available for people to access and complaints made had been appropriately investigated.

Two compliance inspectors visited Plane Tree Court to assess whether the service had improved the outcomes for people living there since the last visit in February 2012.

People told us they were treated with respect and dignity. Comments included “I am definitely treated with respect,” “I have everything I need” and “I am very comfortable.”

People spoken with told us the staff were “friendly, nice and helpful.” One person said I have no complaints and I am well looked after.”

We spoke with two visitors to the home who told us they had no complaints about the care their relatives were receiving. One person told us “The staff are friendly and helpful, they do a fine job.”

As part of this review process we saw a report following a visit to the service from Stockport Local Involvement Networks (LINks). LINKs are groups of individual members of the public and local voluntary/community groups who work together to ensure that health and social care services are planned and delivered to meet the needs of the people that use them. No concerns were raised in the report.

We carried out this review to assess whether the service had improved the outcomes for people living at Plane Tree Court.

The people who talked to us said that in the main they were very happy and content with the service provided.

People felt they were safe and that the staff were able to meet their needs.

Some people also felt that very occasionally care staff could be cold or inappropriate, however the overwhelming consensus of opinion was that the home was effective in meeting needs and people liked living at Plane Tree Court.

Comments included:

“I think they’re alright with the way they treat x."

And

"The girls? I know all of them, we have a good rapport."

We visited the home on a Saturday because we wanted to see how well the home functioned when the manager was away, we had also been told that the home was short staffed at weekends.

We found that although sufficient staff were on duty there were still major concerns about how care was planned and delivered for some people living at Plane Tree Court. We have therefore issued a Warning Notice to the provider in respect of Outcome 4 - care and welfare of people who use services.

In the main people who lived at Plane Tree Court care home said that the service met their day to day needs.

They told us that:

“The staff try their best, they are always friendly.”

“Staff look after me very well, I have no complaints.”

"It's nice and relaxed here now."

"The staff here are very very good."

And

"There doesn’t seem to be much one to one but when staff are needed they will come."

One person stated that staff gave them a choice and were respectful. Another person felt that at times they were ignored and treated as a child.

People said that they couldn’t remember giving consent for treatment or procedures. However, comments included: “Yes they know what I like and will ask me if things are ok.”

People we talked to had mixed feelings about whether or not their health and welfare needs were being met at Plane Tree Court. Comments included “Yes if I tell them about anything it get’s sorted out" and “I am quite comfortable they know exactly what I want.” Another person told us they weren’t always listened to or treated well.

People told us that they were supported to access routine and specialist health and social care when required. Comments included: “Only got to mention something not quite right and they get the doctor out before I can turn round” and ‘‘I’m due to go to the hospital at the end of the month, my daughter will come with me but if not one of the girls will.”

People we talked to had differing views about whether there were enough staff on duty. Comments included “Generally yes there are enough” and “No they are too hard worked; the poor little things are flying around like nobody’s business trying to get done before dinner. I feel so sorry for them sometimes.”

During this inspection we spoke with seven people who lived at the home, four visitors, two visiting healthcare professionals, four members of staff, the training manager, the director and the deputy manager.

People we spoke with told us that they were happy and had no complaints. Some of the comments we received were: “The food is good, well cooked, well presented and there is plenty of it,” “The girls are very good,” “We are well looked after no doubt about that,” “I couldn’t ask for more, I have everything I need,” “They always ask before they do anything” and “They do have activities I like the sing songs.”

We spoke with two visiting healthcare professionals who both said they did not have any concerns.

We had no concerns regarding the training and supervision provided to staff. Staff spoken with told us they thought training was very good and a good standard of care was provided to people.

We found some improvements were needed to ensure consistent and accurate recordings in peoples care records.

We found that formal systems were not in place to evidence that people had given their consent to care and treatment.