About the service:

Trees is an "extra care" housing provision operated by Hill Homes Care Limited. This service provides care and support to people living in specialist 'extra care' housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is rented and is the occupant's own home.

People's care and housing are provided under separate contractual agreements. CQC does not regulate the premises used for extra care housing; this inspection looked at people's personal care and support service.

At the time of this inspection, approximately 37 people were receiving care support.

People’s experience of using this service:

People told us they were well treated by the staff and felt safe with them.

Staff understood their responsibilities to keep people safe from potential abuse, bullying or discrimination.

Risks had been identified, ways to reduce these risks had been explored and followed appropriately.

People told us they were satisfied with medicines support.

People were treated as individuals who had different likes, dislikes, needs and preferences.

Staff upheld and respected people’s diversity. Staff challenged discriminatory practice.

People’s needs were assessed and had individualised care plans that were regularly reviewed.

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.

People were supported to raise any concerns or complaints if they were unhappy with their care.

People told us that the management listened to them and acted on their suggestions and wishes.

Staff were positive about working for Trees and told us they appreciated the support, encouragement they received from the management.

The management team worked in partnership with other organisations to support care provision, service development and joined-up care.

Rating at last inspection:

Requires improvement (report published on 12 June 2018).

Why we inspected:

This was a scheduled inspection based on the previous rating.

Follow up:

We will continue to monitor the service through the information we receive.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 3 May 2018 and was announced. We informed the provider 48 hours in advance of our visit that we would be inspecting. This was to ensure there was somebody at the location to facilitate our inspection. The service was last inspected on 18 March 2017, where we found the provider to be in breach of one regulation in relation to staff training. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question Effective to at least good. At the inspection on 3 May 2018, we found that the provider had made some improvements but they were not sufficient and they remained in breach of Regulation 18. This is the first time the service has been rated Requires Improvement.

Trees is an "extra care" housing provision operated by Hill Homes Care Limited. This service provides care and support to people living in specialist 'extra care' housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is rented, and is the occupant's own home. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people's personal care and support service.

Trees consists of communal facilities including a dining room, an activities room, garden, hairdresser and laundry facilities. The service is for people living with dementia, physical disability and older people. Not everyone living at Trees received a service under the regulated activity of personal care. The Care Quality Commission only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of our inspection 41 people were living at Trees and 30 people were receiving a personal care service.

The service did not have a registered manager in post. The service was managed by the new Chief Executive Officer and the provider was in the process of recruiting a new manager. 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 2008 and associated Regulations about how the service is run.

Staff did not receive training to help them perform in their role, and regular supervision to enable them to support people effectively with their individual needs. People’s medicines administration charts were not robust. We have made a recommendation in relation to recording of medicines administration. People’s care plans were not person-centred and did not give staff sufficient information to deliver personalised care. There were gaps in annual care reviews and people’s care plans were not always updated following a change in their needs. People’s end of life care wishes were not recorded in their care plans. We have made a recommendation in relation to end of life care planning and recording.

There was a lack of overall sight of the management of the service. The provider did not have robust processes to asses and evaluate the service delivery. The management had identified issues but did not always act on them in a timely manner. The provider had not sought feedback from people, their relatives and staff to continually strive to improve the service.

People and relatives told us the service was safe and found staff trustworthy. People were safeguarded against harm and abuse and staff knew how to identify and report abuse. Staff were knowledgeable about risks to people and how to manage those risks. There were enough suitable staff to meet people’s needs safely. People were happy with medicines support. The provider met infection control requireme

This inspection took place on 18 March 2016 and was announced. We told the provider 48 hours before our visit that we would be coming. We gave the provider notice of our inspection as we needed to make sure that the registered manager or another appropriate member of staff would be available in order for us to carry out the inspection.

This inspection was the first inspection of this service since it was registered with the CQC in March 2015.

The service provides personal care for people living in an extra care scheme. Extra care schemes are places which enable people to live independently but can access tailor made and flexible care support when required. At the time of the inspection, Trees, was providing care to 25 people. The service provides personal care, escort and support services to older people some of whom are living with dementia or have physical disabilities.

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.

On the day of the inspection we visited the extra care scheme, which included the service’s main office. On entering the scheme we found that the environment was welcoming and clean and when walking around the scheme we observed there to be a calm and relaxed atmosphere.

People who used the service felt safe and secure with the staff that supported them with their care needs. The provider had taken steps and arrangements were in place to help ensure people were protected from abuse.

The provider had recruitment and selection procedures in place to ensure that the staff employed by the service were safe to work with people. However, the service did not always verify references to ensure that references received were by the person completing the request.

Staff that we spoke with demonstrated that they had the knowledge and skills they needed to perform their roles. People that we spoke with confirmed this. However, training records that we looked at and the service’s training matrix highlighted that some staff had not received training especially in mandatory subjects such as Mental Capacity Act 2005 (MCA) and medicine administration.

The registered manager explained that staffing levels were determined based on the number of shifts that needed covering and people’s level of need. However, some staff that we spoke with told us that they felt that there was not enough staff allocated per shift to meet the need of all the people they provide care to.

People received personalised care that was responsive to their needs. Care plans were person centred, detailed and specific to each person and their needs. Risks associated to people’s needs and requirements were assessed and were personal to the person receiving care. People had seen their own care plan and were consulted on a regular basis to review and record their care preferences. Care plans were signed by people or their relatives receiving care.

People were able to make their own choices and decisions. The registered manager and care co-ordinators were aware of the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). When speaking with the registered manager we identified that some people living at the scheme may be subject to a DoLS authorisation as they lacked capacity and were unable to leave the building of their own free will. The registered manager told us that she will speak to the local authority DoLS team to gain further advice in this area. Staff we spoke with had a basic understanding of the MCA but had not received any formal training in this area.

During the inspection we observed positive caring relationships had been developed between people who used the service and sta