About the service:

¿ Treehaven Rants provides accommodation with personal care for up to 12 people living with autistic spectrum disorders and/or learning disabilities. The premises consisted of two bungalows that each provides four ground floor bedrooms and a self-contained flat.

People’s experience of using this service:

¿ Areas of the service looked tired and some furnishings and fittings were damaged and in need of redecoration or repair. For example, flooring in the kitchen area had holes in it. There was no dedicated maintenance person, since the last one left and maintenance has been carried out by an external contractor. This meant that small jobs were either not completed or there were long delays in responding to needs.

¿ The registered manager told us that the redecoration and replacement of furnishings was included in the provider’s annual development plan. However, although the annual development plan contained some details about improvement work, it did not contain details of the plans to re-decorate and refurbish the service. Following the inspection we were sent a maintenance list that showed areas that needed to be addressed and we saw that some improvements had been completed.

¿ The registered manager told us they had secured a regular company to provide the maintenance of the service and we saw that some work had commenced. For example, the gardens were being maintained on the day of our visit and improvements had been made to the driveway.

¿ People continued to feel safe living at the service. Risks to people’s health, safety and welfare had been identified and were known by staff. Staffing levels were appropriate to meet the needs of the people using the service. Medicines were safely managed. The service was clean and hygienic, although some areas were difficult to keep clean because they were damaged. There were systems in place to monitor incidents and accidents and learn from these.

¿ People’s care, health and cultural needs were identified so staff could meet these. The staff were skilled and competent and knew the people they supported well. People said they liked the food served and had a choice of different meals. People were supported to maintain good health and referred to health professionals when required. Staff worked within the principles of the Mental Capacity Act (MCA) 2005 and ensured people consented to their care.

¿ People continued to receive care from staff who were kind and caring. People were encouraged to make decisions about how their care was provided and their privacy and dignity were protected and promoted. People had developed positive relationships with staff who had a good understanding of their needs and preferences.

¿ People received person centred care that met their needs. Care plans were person centred and set out how staff should meet their needs. The staff team were knowledgeable about people’s needs. Managers and staff ensured information was provided to people in an accessible format. People took part in a range of group and one-to-one activities depending on their preferences. People said they knew how to make a complaint if needed.

¿ People, relatives and staff told us the service was well managed and had an open and friendly culture. Staff said they felt well supported and the management team were open and approachable. The provider’s audit system covered all aspects of the service and helped to ensure the care people received was appropriate and safe. Managers and staff worked in partnership with other agencies to ensure people got the care and support they needed.

More information is in Detailed Findings below:

Rating at last inspection: Good (report published 15 June 2016)

Why we inspected:

This was a planned inspection based on the rating at the last inspection. At our last inspection we rated the service Good. At this inspection we found the effective domain had changed to requires improvement. The overall rating for this service re

Treehaven Rants is registered to provide accommodation and care for a maximum of 12 adults who have autism and/or learning disabilities. At the time of our inspection there were eight people living in the home.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 were safe and lived in a safe environment because there were enough well trained staff to support people and appropriate recruitment checks were carried out before staff began working in the home. Identified risks to people’s safety and wellbeing were recorded on an individual basis. There was clear and detailed guidance for staff to be able to know how to support people safely and effectively.

Medicines were managed, stored and administered safely in the home and people received their medicines as prescribed.

People were supported effectively by staff who were skilled and knowledgeable in their work. All new members of staff completed a full induction and staff were supported well by their seniors, the manager and the deputy of administration.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and to report on what we find. These safeguards protect the rights of adults using the services by ensuring that, if there are restrictions on their freedom and liberty, these are assessed by professionals who are trained to assess whether the restriction is needed. Appropriate DoLS applications had been made for all eight people currently living in Treehaven Rants.

People were supported to eat and drink sufficient amounts and, when necessary, people’s intake of food and drinks was monitored and recorded. Prompt action and timely referrals were made to relevant healthcare professionals when any needs or concerns were identified.

Staff in the home were caring and attentive. People were consistently treated with respect and staff preserved people’s dignity. People were encouraged and supported to be as independent as possible and their relatives were welcome to visit them. People were also supported to undertake activities or hobbies of their choice.

Detailed assessments were completed prior to admission, to ensure people’s needs could be met. These assessments were also reviewed and updated on a regular, on-going basis. People were involved as much as possible in planning their care and received care and support that was individual to their needs. Risk assessments detailed what action was required or had been carried out to remove or minimise identified risks.

People were supported to raise concerns or make a complaint if needed. Concerns were listened to, with appropriate responses, and remedial action was taken where possible.

The service was being well run and people’s needs were being met appropriately. The manager and deputy of administration were approachable and open to discussion. Communication between the staff, management and people living in the home was frequent and effective. However, some staff said they would appreciate more direct communication and updates from the provider regarding the service. To try and address this issue, the provider had appointed an employee relations officer at the beginning of 2016. In addition, a staff representative had also been elected for the service.

There were a number of effective systems in place in order to ensure the quality of the service provided was regularly monitored. Regular audits were carried out by the manager and the provider’s compliance manager. These identified areas that needed improvement and appropriate action was taken to do so.

One person we spoke with told us that they were looking forward to going on holiday and that they were spending Christmas with their family. This person told us they were, “Very happy” living in Treehaven Rants.

Another person was listening to music in their room, which they expressed they enjoyed very much. A third person was watching films in the lounge and indicated that they particularly liked westerns.

Staff we spoke with showed a good understanding of individuals’ specific support requirements. For example, some people living in the home didn’t want a female supporting them and we saw that staff worked in accordance with this requirement.

Meetings were held each evening with people living in the home to choose what they wanted for their meals the following day. We saw that photographs of real food were also used, to help people make informed choices.

No errors or omissions were noted from the Medication Administration Records (MAR) we looked at.

The staff records showed that staff completed a full induction upon commencement of their employment and we saw records of training that had been undertaken. Staff confirmed that they received regular support and supervision with their line managers.

We noted that people living in the home were regularly supported to make their views known during meetings and one-to-one time with staff.

People we spoke with told us they liked living in Treehaven Rants. One person told us that the staff were nice and knew how to look after them properly.

Another person told us that they had recently got a new computer, which they were pleased with and told us that they had really enjoyed their holiday that year. This person also told us about their family pets and said that they liked visiting their relatives.

One person we spoke with showed us their activities timetable and said they enjoyed the horticulture.

We met and spoke with one person, who was playing music in their room. They told us they really enjoyed their music.

Two people we spoke with said that the staff were good and supported them well.

The people we spoke with said they felt safe living in Treehaven Rants. People also told us that they had regular meetings and that they could talk to staff if they had any concerns.

Two of the staff members with whom we spoke told us that all the support plans are completely person centred and that it is very important that all the staff know how each person wants and needs to be supported and what their personal routines are.

Staff told us that communication is very good between the staff and that there are good handovers, comprehensive daily notes and relevant information about people living in Treehaven Rants is shared appropriately at all times.

A number of staff commented that lots of things have very much improved over the last few months.

The staff with whom we spoke all told us that they have either started or completed a full induction process and one person said the induction is good because "…it makes you search for more if you don't know the answers…" We were told that the induction includes a lot of information about safeguarding as well as actual training in adult protection and abuse awareness.

When asked whether restraint was ever used, staff told us that they have received training in NAPPI (Non Aggressive Psychological and Physical Intervention) and PMA (Prevention and Management of Aggression) and breakaway techniques.

A new member of staff told how they had recently observed a more experienced carer spend twenty minutes very quietly and calmly de-escalating a potentially volatile situation by using non-physical 'diversion' techniques.

Another member of staff told us that 'safe-holding moves' are occasionally required - if out in the community for example and a person's safety is at risk - perhaps with a busy road, but any such incidents are always fully recorded on the relevant accident and incident reporting sheets.

When we asked the staff what they would do if they ever saw something they thought was wrong everybody told us that they would report it immediately. One person said: "…the organisation is very strict and will not tolerate any form of abuse…" Another person told us how they had 'whistle-blown' in the past. They told us how they had been very well supported by the organisation and that they would have no hesitation doing the same thing again should the need ever arise.

Staff members with whom we spoke told us that the management team always have an open door policy and any issues or concerns can be raised and discussed at any time.