We carried out this announced inspection to Tall Trees on 14 December 2017. Tall Trees is registered to provide accommodation with personal care for up to three people with physical and learning disabilities. At the time of our visit three people lived at the service.

At out last inspection, the service was rated Good. At this inspection we found the service remained Good.

People were supported by sufficient, skilled staff to meet their needs and robust recruitment processes were in place to ensure only suitable staff were employed. Risks to people had been identified and as such staff took appropriate steps to help mitigate any risk of harm of injury to people. Staff were aware of their responsibilities in safeguarding people from abuse.

Staff received on-going training, induction and supervision to support them in their roles. They were knowledgeable in relation to infection control and what to do in the event of a fire.

People were supported to make their own decisions about their care and encouraged to be independent as much as they could. Where there were restrictions in place staff had followed legal guidance in order to help ensure these were in people’s best interests.

People received support from staff who knew them well and positive relationships had developed. Staff treated people with kindness and were aware of their preferences. Staff demonstrated a good understanding of people’s communication styles and ensured people received care that focused on people’s health and wellbeing. People received the medicines prescribed to them and staff sought advice from health and social care professionals to help ensure people received the most appropriate, effective and responsive care.

People had access to nutritious food of their choosing. People’s care records were person centred and completed in detail. Care plans were regularly reviewed and updated to ensure staff had up to date guidance regarding people’s care. People had access to a range of individual activities in line with their interests.

People lived in an environment that was homely and suitable for their needs. The service was clean and hygienic and people had access to communal areas, a garden and their own bedrooms which were individualised.

Systems were in place to monitor the quality of the service provided and ensure continuous development. People and staff were involved in the running of the home and relatives played an active role. The service had a registered manager, who although also managed another of the provider’s services, demonstrated good management oversight of the service. Staff felt supported by the registered manager as well as the deputy manager.

Tall Trees provides accommodation, care and support for a maximum of three adults with learning disabilities. There were three people using the service at the time of our inspection.

The inspection took place on 2 October 2015 and was unannounced.

There was no 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 and associated Regulations about how the service is run. The manager had started work at the service in August 2015 and had applied for registration with the Commission.

People were kept safe because staff understood their responsibilities should they suspect abuse was taking place and knew how to report any concerns they had. Risks to people’s safety had been assessed and measures had been put in place to minimise these risks. There were plans in place to ensure that people would continue to receive safe care in the event of an emergency.

There were enough staff on duty to keep people safe and meet their needs promptly. The provider had a robust recruitment procedure to help ensure only suitable staff were employed. People’s medicines were managed safely.

Staff had access to the training they needed to provide effective care and support. They had an induction when they started work and regular refresher training in core areas, Staff were well supported in their work. They met with their managers regularly to review their performance and to discuss any issues with which they needed support. Staff said that morale was good and that they worked well together as a team. Staff had opportunities to discuss any changes in people’s needs to ensure that care was being provided in a consistent way.

The team leader and staff understood their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). People’s best interests had been considered when they needed support to make decisions and applications for DoLS authorisations had been submitted where restrictions were imposed to keep people safe.

People’s nutritional needs were assessed and any dietary needs were managed effectively. Staff enabled people to make informed choices about what they ate and supported them to maintain a balanced diet. People were supported to maintain good health and to obtain treatment when they needed it. The service had effective relationships with healthcare professionals which ensured that people received the care and treatment they needed.

People had positive relationships with the staff who supported them. Staff treated people with respect and supported them in a way that maintained their privacy and dignity. Staff used a range of techniques to make sure people had the information they needed to make informed choices and to understand information that was important to them. Relatives told us that their family members enjoyed living at the service and that staff provided high quality care. Relatives said staff communicated with them well and kept them informed about their family member’s health and welfare.

People received care and support that was tailored to their individual needs. Support plans were person-centred and provided information for staff about how to support people in the way they preferred. People’s needs and wishes were reviewed regularly and relatives told us that their contributions to reviews were encouraged and valued.

Staff promoted people’s involvement in their local community. Relatives told us that their family members were supported to enjoy fulfilling lives and to be as active as they wished. People were supported to pursue their interests and to maintain relationships with their families.

The provider sought the views of relatives, staff and relevant healthcare professionals about the quality of the service. Relatives told us they were consulted when decisions were being made about their family member and that the service acted on their views about the care and support their family member received.

The complaints procedure detailed how complaints would be managed and told people who they could contact if they were not satisfied with the provider’s response. All the relatives we spoke with said they would feel comfortable making a complaint if necessary and were confident that any concerns they raised would receive an appropriate response.

Staff received good support from their managers. They said there managers promoted an open culture in which they could discuss issues and raise any concerns they had. Staff met regularly as a team and had opportunities to discuss any changes in people’s needs, which ensured that they provided care in a consistent way.

The service had implemented an effective system of quality checks to ensure that people received safe and appropriate care and support. Shortfalls or areas identified for improvement were incorporated into the service continuous improvement plan, which was monitored regularly to ensure were responded to appropriately.

The last full inspection of the service took place on 31 December 2013. We identified a breach of the Regulations in relation to Staffing. We carried out a desk based review in February 2014 which found that the provider had taken action to meet the Regulations.

People who used the service had individual and complex communication needs. This

meant we were not able to hear their views directly. To understand people's experiences,

we observed interactions between staff and people, looked at records and spoke with staff

about how they supported people.

During our inspection we saw that staff treated people with respect and took account of their wishes. We saw that staff gained consent from people by asking questions and observing their responses. For example their body language and facial expressions.

We found that staff had knowledge of healthy eating and encouraged people to eat a balanced diet. We saw that there was a variety of nutritious food and drinks available for people.

We saw that there were cleaning schedules in place and staff told us these worked well. We found the home to be clean and tidy. Staff had received training in infection control and were knowledgeable about how to minimise the risk of the spread of infection.

On the day of our visit we found that there were two staff on duty, which included the team leader. We asked staff if they thought there were enough staff to support people effectively and were told that there were not. When asked, staff told us that there used to be a floating support staff member, but they had been moved to another home.

We saw that the provider had a complaints policy and that this was in an easy read format for people who lived at the home. We were told that the provider had not received any complaints. When asked, the staff we spoke with knew what to do if they received a complaint.

People who used the service had individual and complex communication needs. This meant we were not able to hear their views directly. To understand people's experiences, we observed interactions between staff and people, looked at records and spoke with staff about how they supported people.

We found that people's needs were assessed and that care was delivered in line with their individual care plan. Guidance about how to support people was available to staff, which meant that staff provided support in a consistent way. We saw that staff promoted people's independence and choice and that people's diversity, values and human rights were respected.

There was evidence that people were supported with medical appointments if they needed them and that the home made referrals where necessary to other health and social care professionals.

We found people had opportunities to take part in social and leisure activities within their local community and were involved in decisions about activities they took part in.

We found that people who use the service were protected from the risk of abuse because staff were trained in safeguarding adults and were able to tell us how they would report abuse or alleged abuse.

People who use services at Tall Trees have multiple or complex needs. It was therefore difficult to ask them about their levels of satisfaction with the outcome areas reviewed.

We observed however that people using services, appeared relaxed and at ease in their surroundings. We saw good interactions between staff and people who use the service when they were preparing to go on an outing.

Two of the three people using services were out of the home on the day of our visit. Records showed them to be taking part in planned day care activities.