This unannounced comprehensive inspection took place on 11 and 13 June 2018.

Tree Tops Residential home is located in a residential area of Rainhill within walking distance of a train station. The service provides residential care without nursing for up to 43 people. People living in the home nay be living with dementia. At the time of the inspection there were 41 people living in the home. The home comprises of two units; the Tree Tops unit accommodated 28 people and Delphland unit accommodated 13 people living with dementia.

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and we reviewed both areas during this inspection.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service had a registered manager in post. 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.

Risks to people were assessed and measures put in place to manage identified risks and reduce the likelihood of harm occurring.

Staff had received training in relation to safeguarding adults from abuse and understood what actions they should take when concerns are identified.

Safe recruitment processes were in place to ensure that newly recruited staff were safe to work with vulnerable adults.

Medicines were managed and stored safely and people received medicines at the right times.

People received care and support from staff who received appropriate training and supervision for their role.

Consent was gained in accordance with the Mental Capacity Act 2005 (MCA); staff understood the need to obtain consent from people prior to offering support.

People's dietary needs were understood and met and people were provided with food and drink appropriate to their needs.

People were supported with access to other health and social care professionals; care records showed evidence of additional support from GPs, opticians, district nurses and social workers.

People were treated with dignity and respect; staff ensured privacy was maintained at all times. Interactions between staff and people were positive and staff showed a good knowledge of the people they supported.

People’s care and support needs were reviewed regularly and updated where appropriate. Care and support plans were based on individual needs and person centred.

The quality and safety of the service was assessed and monitored regularly and improvements made when required. The management team were open and inclusive and showed a desire to maintain and improve on the quality of the service being provided.

During our visit, we observed people using services, when they were able, giving consent to any care and treatment they received. The provider had systems in place which gained and reviewed consent from people and acted on them. Care plans and risk assessments we observed were up to date and contained clear and relevant information related to all people using services and records showed they were reviewed regularly for effectiveness. People said they "could not be happier at Tree Tops" and "would recommend it without a doubt". People were protected against the risks associated with medication because the provider had appropriate arrangements in place to manage medicines. Medicines were kept safely,and administered and disposed of appropriately.

Tree Tops Residential Home had sufficient numbers of staff with the right skills, knowledge, experience and qualifications to meet the needs of people using services at all times. The provider had appropriate processes for gathering, recording and evaluating accurate information related to the quality of care and treatment the home provided and its outcomes.

When asked about the care they received, people told us "The staff are really nice. I know who my key carer is, and if they are off, the staff tell me who will be looking after me. It's always someone I know."

One person we spoke with said she felt very at home saying "I have been here for quite some time and I'm very happy. I have lots of company and the staff are really caring. I like it here."

Another person expressed how much they enjoyed the company of the staff, saying "If I want to go for a wander, they always help me."

We asked people if they had enough to eat and drink, and if they had variety. One person told us "The food here is really good, there is a lot to choose from, but I would like an all day breakfast!"

We spoke with relatives, asking them about the care delivered. Responses were positive; one relative said "The Manager is very approachable. She keeps us up to date with any changes, and they contact us quickly if there is any change in XX condition. When XX had an accident, they really supported them in getting back to full health, encouraging their independence every day. Overall, they do a very good job."

We asked staff how they found working at the home. Again responses were positive from all. One member of staff told us "I really enjoy working here, there's a really nice atmosphere. I enjoy spending time with the people, but some days I wish I had a little more time to sit and chat with them."

An anonymous concern was raised with the Commission about staff being rude to the people using the service and there sometimes being insufficient staff. In the light of this, the inspection focussed on observing the way staff interacted with the people using the service and obtaining their views about the care they receive. We also talked with people's relatives and healthcare professionals involved in the service.

Limited information was obtained from the people using the service due to communication difficulties. However their comments included:

“The staff are very kind.”

“I like living at the home.”

“The girls are lovely.”

“The staff are very good.”

“I really enjoyed my lunch.”

The relatives of the people using the service were very happy with the standard of the care provided. Their comments included:

“The staff are lovely.”

“The manager is very good and very caring. She runs a good home and is very efficient.”

“The manager is excellent, there is always good communication.”

“The manager is brilliant, she always knows about my relative’s care needs. I would recommend this home to anyone.”

“The staff are excellent, they always keep me informed about what going on.”

“The staff attitude is very good, they are very caring. The staff team is consistent which is good.”

“The staff are very quick to respond to issues. They will call the doctor straight away, they are very professional. I would recommend this home.”

“The home has a lovely atmosphere and is very calm, I’m always made welcome.”

“My mum had an accident while she was in the home. The staff member who accompanied her to hospital was lovely, she gave her lots of reassurance. I really would recommend this home to anyone.”

Health care professionals involved in the service praised the staff team for the way they look after the people using the service. They said the home was very well managed. Their comments included:

“The staff are very good, they always keep me informed about any issues and carry out my instructions well. I have never seen staff carry out bad practice or seen signs of abuse’. I would recommend this home.”

“I’ve always had a good working relationship with the manager and staff. The staff are responsive and proactive and I have never had any difficulties with the home. The manager is very good.”

“The staff are always welcoming and friendly. I am always kept informed about what’s going on with client. The manager is very efficient and responds quickly to requests and feeds back information promptly. I have only had positive feedback from relatives about the care provided.”

“Communication with the manager is good. She is very efficient and I am always kept informed about my patient’s care needs. The staff follow instructions well. I have never seen any signs of abuse and never heard staff speak badly to residents. I would recommend this home to any relative.”

“The staff are very good and I have a good relationship with the manager who will ring for advice and make a referral to the GP appropriately. The manager is always aware of peoples’ care needs. I provided the staff with some training earlier in the year. Staff have taken on board this training and I have noticed an improvement in the way they manage one aspect of peoples’ care needs.”

“I have never seen any bad practice in the home. The care is good and the staff are friendly and professional.”

This was an unannounced inspection, carried out over two days on the 25 and 26 of November 2015.

Tree Tops care home provides residential care without nursing for up to 43 older people. People living at the home may be living with dementia. There were 42 people living at the home when we visited. The home comprised of two units, the Tree Tops unit accomodatiing 30 people and Delphland unit accommodating 13 people with dementia. Tree Tops care home is located in a residential area of Rainhill within walking distance of a train station. Parking is available at the service.

There was a registered manager in post. 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 previous inspection on 16 and19 February 2015 we found that the registered provider was not meeting seven regulations. These related to medication, complaints, management of risks, training and quality assurance monitoring. The registered provider sent us an action plan outlining how they would make improvements. We checked for improvements during this inspection and found that the registered provider had made the necessary improvements to comply with these regulations.

People we spoke with and their visiting relatives told us they were satisfied with the care and support they received from Tree Tops. People told us they had developed good relationships with the staff and told us they were treated with dignity, kindness and respect and they felt safe living in the home.

During this inspection we found that people’s risks were identified, managed and reviewed and the staff understood how to keep people safe. There were sufficient numbers of suitably qualified staff to meet people’s needs and promote people’s safety. We saw that staff listened to people and encouraged them to make choices and decisions about their care. Staff sought people’s consent before they provided care and support.

Some of the people who lived in Tree Tops did not have the ability to make decisions about some parts of their care and support. Staff had an understanding of the systems in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People who lived in the home and their relatives said, they were confident that any issues or concerns they raised would be responded to appropriately by the registered manager or the registered provider.

The staff had a good understanding of the needs of people they cared for and were positive about their roles and the organisation.

People were supported to access healthcare professionals whenever they needed to.

Staff recruitment procedures were robust, which ensured that appropriate checks were carried out before new staff commenced employment. Staff received a thorough induction and on-going training to ensure they had up to date knowledge and skills to provide the right support and care to people. Members of staff also received regular supervision, appraisal and observations of their work practice.

Staff were complimentary about the registered manager and the registered provider and had no concerns about raising any issues.