Tree Tops provides accommodation and personal care for up to 10 adults with learning disabilities, physical disabilities and/or sensory impairment. Accommodation is provided over three floors with lift access. The service is suitably designed for people who use wheelchairs. On the day of the inspection there were 10 people using the service. People had a range of needs, with some people living with epilepsy and other healthcare needs.

At the last inspection in November 2014, the service was rated Good.

At this inspection we found the service remained Good.

The service demonstrated they continued to meet the regulations and fundamental standards.

Improvements had been made to the well-led question and we have revised this rating to good. Quality monitoring systems had been strengthened. Audits and checks were in place to ensure the service ran effectively. People, their relatives, staff and other stakeholders were involved in developing and improving the service.

The registered manager continued to provide good leadership and led by example. Staff felt supported and there was open communication.

Staff had the information they required to meet people's needs. Care records were individual and kept updated according to any changes in people’s health and wellbeing. Staff received appropriate, ongoing training and regular supervision and appraisal to support them in their roles.

Arrangements were in place to protect people from the risk of harm and abuse. Risks to people’s health and wellbeing were identified and action was taken to minimise these risks. There were systems for checking that people received their medicines correctly and that staff administered medicines safely.

People received effective care and support because there were enough staff to meet their needs. The recruitment and selection process helped ensure the right staff were employed.

Staff treated people with dignity, respect and kindness. People’s care records recognised their rights and were person centred. 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.

Tree Tops was comfortably furnished and equipped with appropriate aids and adaptations to meet people’s individual needs. Health and safety checks were carried out to make sure the premises and equipment was safe for people to use.

People were supported by staff who knew them well and understood their needs, preferences and interests. Staff communicated with people using their preferred methods of communication.

People took part in social events and activities both inside and outside the home and maintained relationships with people that mattered to them.

Staff worked well with external health and social care professionals to ensure people received the services they needed.

Further information is in the detailed findings below.

This inspection took place on 11 November 2014 and was unannounced.

At our last inspection in September 2013 the provider met the regulations we inspected.

Tree Tops provides accommodation and personal care for up to ten adults with learning disabilities some of whom also have physical disabilities and/or sensory impairment. Accommodation is provided over three floors with lift access. The service is suitably designed for people who use wheelchairs. On the day of the inspection there were eight people using the service.

There was a registered manager in post who had worked in the service since June 2014. 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 provider carried out regular audits to monitor the quality of the service and to plan improvements. However, action plans were not used effectively to monitor whether necessary changes had been made. There were also no arrangements to capture the views of people who used the service, their relatives and external professionals involved with the service. This meant they did not have formal opportunities to influence service improvement and the way Tree Tops was run.

There were positive interactions between staff and people who used the service. People were offered choices, supported to feel involved and staff knew how they should respond to their communication styles or body language. People were relaxed and comfortable in the company of staff.

People’s needs were assessed, monitored and reviewed. Care plans and risk assessments were followed which ensured that people received the care and support they required. We saw that these were regularly reviewed to ensure the care was current and relevant to people’s needs. People were provided with a range of activities in and outside the service which met their individual needs and interests.

Where people did not have the capacity to consent, care was provided in their best interests. A wide range of health and social care professionals were involved in people's care. Others close to them, such as their family members, were also involved.

Staff recruitment procedures helped ensure that people were protected from unsafe care. There were enough staff to provide the level of care and support each person needed. Staff received regular training and management support to meet people’s needs.

Tree Tops was undergoing refurbishment and redecoration. We found the service was clean, safely maintained and furnished to comfortable standards. Consideration had been given to the needs of people with physical and sensory disabilities and they were provided with specialist equipment to promote their independence and meet their assessed needs.

People were treated with respect and dignity. Staff showed patience and gave encouragement when supporting people. They were knowledgeable about the care needs of people using the service and the ways in which individuals liked to be supported.

People were supported to keep healthy. Any changes to their health or wellbeing or accidents and incidents were responded to quickly. Referrals were made to social and health care professionals to help keep them safe and well.

There was an open and inclusive atmosphere in Tree Tops and the manager led by example. Staff felt well supported and able to discuss any issues openly with the manager. Health and social care professionals told us the registered manager worked with them to implement their recommendations to improve the service.

During our inspection we met seven of the people who use the service as two people had already left to go to a local day centre. We spoke with two people. They told us they got on well with the staff. One person told us “It’s nice, we go to the park.” Another person told us “All the staff are great.”

Most of the people living at TreeTops did not have the capacity to share their views regarding their care. In order to make judgements about the care that individuals received, we observed interactions with staff and the care provided. We saw that the staff understood each person’s non-verbal communication signs well and that people were treated with dignity and their wishes respected.

We found that people received effective and safe care and support from staff that were familiar with people’s individual needs and preferences. We spoke to two relatives of people who used the service who visited regularly. One of them said “I love it! I always go unannounced and X is always well cared for and well dressed.” Another told us “The staff genuinely care for her, they are brilliant.”

We spoke with two health professionals who were visiting the service on the day of the inspection and another afterwards. They told us that the service worked closely and effectively with them. We saw from the care records that the service worked with a wide range of other agencies and professionals.

Staff were knowledgeable about safeguarding procedures and there had been no safeguarding alerts or concerns raised. We saw evidence that regular checks were made of equipment at the service and that there was an adequate supply of hoists and wheelchairs.

Staff were trained to meet the needs of people at the service. The service carried out a range of audits to monitor the quality and safety of the service. People’s views about the service were also sought.

Some people who use the service had limited or no verbal communication skills however each person had a communication profile indicating their method of communicating that they and members of staff understood.

One person who uses the service told us “I like it here, it's good, the staff are nice”. A relative of a person using the service told us ”I am very happy with the way they treat my brother. They looked after him really well when he was ill over Christmas. The staff are really helpful and keep in touch”. They told us if they had any concerns about the service they would contact the home and the registered manager or deputy manager would do something about it.

We observed positive interactions between staff and people using the service during the course of our visit.

Some people who use the service had limited or no verbal communication skills however each person had a communication profile indicating their method of communicating that they and members of staff understood. We spoke to two people who use the service. Both told us that staff treated them with dignity and respect. One person told us they went to day services four times a week and they got to go out quite a lot for social activities. Another person told us they visited their family every weekend and sometimes they went to Church. Both told us they had regular contact with their care managers. One person told us they had a care plan and knew what staff needed to do in order to support them to do the things they wanted to do. We observed positive interactions between staff and people using the service during the course of our visit.