We carried out an unannounced inspection of the service on 25 October 2017

The Trees provides accommodation for persons who require nursing or personal care who are living with learning disabilities. The Trees is a purpose built home and provides care on a short and long term basis for up to 19 adults who have been diagnosed as having learning disabilities, mental health conditions, and physical disabilities. The service consists of three units, Beachwood, Ashwood and Cedarwood, each unit provide communal and living quarters for people who used the service. There were seven people receiving care and three people in respite care at the time of our visit. The service was last inspected 30 November 2015 and the rating for that inspection was Good.

There was a manager registered with the Care Quality Commission (CQC). 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 the previous inspection in October 2015 we found staff had difficulty recognising when people showed signs of distress, so they could administer 'as required' medicines appropriately. At this inspection we found improvement had been made. Records showed a distress assessment tool had been implemented and added to individual medicine care plans where people required PRN medicines when they were in distress.

People were observed to be living in a safe environment and kept safe when staff supported them. Risks were assessed and managed. Sufficient staff were in place and safe recruitment process were followed.

There was an training programme in place that provided in depth and relevant knowledge and skills to fully equip staff to meet the individual needs of people. Staff received regular supervision and felt well supported by the management team. The principles of the Mental Capacity Act 2005 (MCA) were considered when supporting people. People were supported and encouraged to follow a healthy and balanced diet. People’s day to day health needs were met effectively by the staff.

People experienced positive caring relationships with staff that treated them with kindness and compassion. Staff showed good awareness of people’s needs and preferences. People were treated with respect and dignity. People were supported to express their views and be actively involved in making decisions about their care. People were supported to live as independently as possible.

People were aware how to raise concerns or complaints and were encouraged to do so if needed. The provider followed their procedures to ensure any complaints or concerns were dealt with in a timely manner.

Staff spoke highly of the registered manager and the service provided. A number of systems were in place that enabled people, staff and relatives to give their views about the service. Robust quality assurance processes were in place. The rating of the service was displayed appropriately.

This inspection took place on 14 October 2015 and was unannounced. At our previous inspection in October 2014 we found the service did not have suitable arrangements in place for obtaining, or acting on accordance with, the consent of service users in relation to their care and support. This was a breach of Regulation 18 Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which since 1 April 2015 is Regulation 11 of the Health and Social care Act 2008 Regulations (Regulated Activities) Regulations 2014. We required the provider to make improvements. We received an action plan about how those improvements would be made. At this inspection we found that the necessary improvements had been made.

The Trees is a purpose built home for people with learning disabilities, situated in a residential area of Hinckley. The home is run by Leicestershire County Council. The service provides care on a short and long term basis for up to 19 adults who have been diagnosed as having learning disabilities, mental health conditions, and physical disabilities. At the time of our inspection 11 people were using the service.

The service had 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. The registered manger was absent at the time of our inspection and their absence was expected to last more than 28 days. An interim manager was running the service in the meantime.

People using the service were safe because staff understood and practiced their responsibilities for protecting people from abuse and avoidable harm. There had been lapses in the security of people’s finances in January and May 2015. Actions were taken to improve security after the first theft, but these proved to be ineffective. A further review took place, with police involvement after the May 2015 theft.

Staff supported people to be as independent as they wanted to be. Where that involved activities that carried a risk of harm, risk assessments were in place to minimise the risks. Risk assessments were also in place in relation to people’s care routines.

Decisions about staffing levels were based on people’s needs. People using the service felt enough staff were on duty and staff also felt that. Our observations were that there were enough suitably skilled and experienced staff to meet people’s needs.

People received their medicines on time. We found one lapse in the accuracy of a record of medicines administration. The provider told us they would take action to ensure that use of `as required’ medicines was reviewed. The provider had safe arrangements for the storage and disposal of medicines.

People using the service were supported by staff with the necessary knowledge, skills and experience. Staff were supported through training and supervision.

Staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Every person using the service had an assessment of their mental capacity to make a range of decisions about their care and support. Applications for DoLS had been made for people using the service.

People were supported with their nutritional needs. People were supported with their food preferences and dietary requirements. People who required support with eating and drinking received that support. People were supported to access health services when they needed them.

Staff understood people’s needs and provided care and support that helped people feel they mattered to staff. People were involved in decisions about their care and support. They were supported to access independent advocacy services when they needed them. Staff treated people with respect and dignity

People received care and support that was centred on their individual needs. Their care plans included information for staff about how they wanted to be supported. People were supported to maintain their hobbies and interests and to participate in activities that were important to them. They were able to do that at an activities centre and at The Trees. They were also supported to take part in social activities and days out to places of interest.

People had opportunities to express their views at reviews or their care plans, at residents meetings and through everyday dialogue with staff. They and relatives e had access to a complaints procedure. The provider used complaints as an opportunity to identify where improvements could be made to the service.

People using the service, their relatives and staff had opportunities to be involved in developing the service. Their suggestions and ideas were listened to and acted upon.

The service had a registered manager. They were absent at the time of our inspection but interim management arrangements were in place which ensured a continuity of management. The provider had procedures for the monitoring and assessment of the service.

Our inspection took place on 8 October 2014. It was an unannounced inspection. This meant the provider did not know we would be visiting. At our previous inspection on 13 May 2013, we required the provider to make improvements to how staff sought and recorded consent to care and support from people who used the service. The provider sent us an action plan setting out the improvements they were going to make to meet the relevant requirements. Nearly all of the improvements had been made.

The Trees is a purpose built home for people with learning disabilities, situated in a residential area of Hinckley. The service provides care on a short and long term basis for up to 19 adults who have been diagnosed as having learning disabilities, mental health conditions, and physical disabilities. At the time of our inspection 15 people used the service.

The Trees 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 and associated Regulations about how the service is run.

People who used the service gave us positive feedback about The Trees.

People told us they felt safe. People felt that staff had the right skills to be able to support them. Staff had received relevant training. People who used the service and staff felt that enough staff were on duty. Arrangements for the safe storage and disposal of medications required minor improvements. The provider had procedures and guidance for the administration of people’s medicines. However, people’s plans of care did not include guidance about how they should be supported to receive certain medicines.

Staff were knowledgeable about people’s individual needs and supported them in line with their plans of care. New pre-admission procedures had been introduced to ensure that staff had the latest information about people who used the service for short periods at regular intervals.

Staff had awareness of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). This is legislation that protects people who lack mental capacity to make decisions and protects people from the unauthorised use of restraint. Although staff had awareness of DoLS, we found that there had an occasion when staff had used bedrails without a person’s consent. The registered manager was, at the time of our inspection, in the process of arranging training about how to carry out mental capacity assessments. At the time of our inspection no person using the service had had an assessment of their mental capacity to consent to care.

People told us that they enjoyed their meals at The Trees. We saw that people using the service were supported to have balanced and nutritious diets, but staff also respected people’s food preferences.

People were supported to maintain good health because staff supported people to access healthcare services. On the day of our inspection two doctors were at the home. District nurses and other health professionals regularly visited the home.

People knew how they could access advocacy services if they needed them. People told us that staff treated them with dignity and respect and we observed that to be the case. However, we had to ask staff to remove confidential information about a person that was displayed on a notice board that was used by other people. This meant that person’s privacy had not been respected.

People using the service told us they had been involved in their care plans and that staff listened to them and acted upon any concerns.

People and staff were involved in developing the service because their ideas and suggestions about the service were acted upon. The registered manager had procedures for monitoring the quality of service. A senior manager carried out random inspections of the service when they visited the home.

You can see what action we told the provider to take at the back of the full version of the report.

During our inspection of this service we spoke with three people who used the service and five members of staff working at the service. At the time of our visit there were nine people living at the home on a permanent basis and one person was staying at the home for respite care.

The people we talked with who used the service told us that they felt happy living at the home. They told us that the staff treated them with respect and that they could carry out activities which they enjoyed. One person described their bedroom to us and told us they could choose the decor and layout of the room. They said: "I've got new cupboards and new doors in my room, I like it. I am happy."

Staff we spoke with were positive about working at the home. Several of them commented that there had been staff shortages, however, they told us that this had been managed well and that it had not affected the people using the service. We observed the care being delivered to people and concluded that people's needs were being met on a daily basis.

We found the environment of the home to be clean and homely. We observed people moving around the home as they chose to, whilst being supported and encouraged by staff.

We observed fresh food being prepared for people and saw that care was delivered appropriately and safely. We found that people had not always consented to their care and that there was not a robust process in place for obtaining people's consent and acting in their best interests.

At the time of our visit there were nine people living permanently at the home and two people staying at the home for respite care. During our visit we spoke to two people who used the service and five members of staff working at the home.

One of the people using the service who we spoke to told us that they were happy at the home, saying, “It’s alright here. The staff do respect me and I can do what I like to do.” This person added that they were able to get out into the community as and when they wanted to, “I go to the pub, cinema and have a theatre trip in 3 weeks.” Another peron using the service who we spoke to told us, “The food is OK here and I like my room.”

The management staff we spoke to at the home all enjoyed working there and described a very positive environment for staff and people using the service. One staff member told us, “We have a fantastic management team.” Another member of staff commented that, “I feel we have a good rapport with carers and with professionals that come in. We get very good feedback from people.”

We spoke to two support workers at the home during our visit. Both staff members had been working at the home for a number of years. They reported to be very happy at the home. One commented that, “There is a lot of support from the management here. They always check on training needs and always ask if there is anything I would like to do.”

The staff member went on to state that, “There is a whole level of trust at the home. The service users trust us and they also trust the management.”