This inspection took place on 27 February 2017 and was unannounced. The service was last inspected on 24 and 25 November 2015 and was not compliant in all areas. There were two breaches. One breach in Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 Person-centred care as people who lived in the home were not engaged in activities that met their needs and reflected their preferences and Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 Premises and equipment as equipment was not cleaned or properly maintained, nor were the standards of hygiene in the kitchen adequate.

At this inspection we found improvements had been made and the home was now compliant in all areas.

Treetops is a residential care home for up to 28 people who live with mental ill health. At the time of our inspection 22 people were living there. The accommodation consists of an old house with extensive grounds around it.

The registered manager had recently left the organisation. However, at the time of the inspection the operations manager had applied to be the registered manager with the Care Quality Commission. 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.

People were protected from bullying and harassment by staff who were trained and knowledgeable about significant risks to people. The management team and staff were able to explain to us how they protected people’s rights. The principles of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) were adhered to.

There were sufficient numbers of staff to keep people safe. The provider had recruitment procedures in place and only employed new staff once appropriate checks had been completed. The provider ensured new staff participated in an induction which included a period of shadowing an experienced member of staff.

People’s medicines were managed safely. There were procedures in place to ensure medicines were safely stored, administered and disposed of.

People’s nutritional needs were met; special dietary needs were catered for and people were given the choice about where and when they ate their meals. Staff understood people’s health needs and people were supported to access relevant health care professionals when this was required.

Caring relationships had been developed between people and the staff who supported them. People were supported to express their views and were involved in the development and review of their care plans. Staff knew people well and were aware of the importance of treating them with dignity and respect. Staff were kind and caring and people’s self-esteem was promoted and staff supported and encouraged them to remain as independent as possible.

People received care that was responsive to their needs and their needs were met in line with their preferences where this was possible. People knew how to make raise concerns. Staff, the management team and people felt their concerns would be listened to.

Audits were carried out to monitor the quality and safety of the service. Staff supervision and training was provided. Meetings were held with people to give them the opportunity to voice their thoughts about the services they received. Staff we spoke with understood their roles and responsibilities.

At the time of this inspection there were 28 people using the service. We spoke with two people receiving care, the manager and two staff working at the service. We also observed people receiving care and examined records at the service. Below is a summary of what we found.

Is the service safe?

The people who used the service told us that they felt safe living at the service. Most of their personal files included a range of risk assessments and these included procedures to safely manage risks.

People told us that staff sought their consent before carrying out their care and support. One person said they had received vaccinations for influenza and pneumonia and told us, “Staff explained [about these vaccinations]…very helpful.”

We found the service to be meeting the requirements of the Deprivation of Liberty Safeguards. People’s human rights were therefore properly recognised, respected and promoted.

People felt safe and comfortable with the staff who had been appointed to provide care for them.

Is the service effective?

People were involved in planning their lives. A range of activities were provided which reflected their wishes and individual interests and improved their independence. One person told us, “I’m up at four or five in the morning and make myself a coffee.”

Care plans guided staff to meet most people’s needs in a consistent and informed way. However, there were no care plans or risk assessments recorded with regard to one person who had been admitted five weeks previously. This meant that staff had limited written guidance on which to base their care of this person. We have asked the provider to tell us what they will do to meet the requirements of the law in relation to assessing people’s needs and risks they may be exposed to.

Is the service caring?

Staff spoke positively to us about staff attitudes towards people who used the service and told us that staff accompanied people to hospital and on visits to relatives’ homes.

One person who used the service told us that staff, “talk to me…want to know how I am.” We observed, and heard, staff talking respectfully, and with interest, to people who used the service.

Is the service responsive?

People’s personal records showed that staff were encouraged to take an approach to people which was centred on their individual needs. People’s personal preferences, and likes and dislikes, were recorded and support was provided that met people’s wishes.

There were meetings for people who used the service and from these meetings their views were acted on. As an example, people had been given a choice of several day trips. One person told us, “I asked [on the satisfaction questionnaire] for better food and it got better.”

Is the service well-led?

The service had a quality assurance system which identified, assessed and managed risks to people’s health, safety and welfare.

Staff described a sound set of values upon which the service was based. These included respecting people who used the service, treating them as individuals and, “delivering the correct level of care according to need.”

We spoke with most of the people who use the service and also observed the way that staff interacted with people. People told us that they were respected by staff. One person said, “Staff are firm but polite.” We observed staff and the people who use the service mutually respecting each other.

The people we spoke with told us that staff cared for their welfare. One staff member told us, “Residents feel their needs are met.” Records showed that the service was aware of people’s individual needs and preferences, and likes and dislikes.

People told us that they felt safe living at the service. One person said, “Feels safe here. Feels safe when out with staff.” Staff described to us practices that keep people safe.

Staff told us that they felt supported in their work and described a wide range of staff training. Records confirmed that essential training was being carried out.

The purpose of this visit was to check if the provider had taken actions to address the

findings of our visit on 20 September 2012. The provider had sent us an action plan showing that they had addressed our findings in September. We referred to this action plan, and the report from our previous visit, at this visit.

There were 20 people using this service at the time of our visit. We talked with two members of care staff and looked at records of people who use the service. This gave us sufficient evidence of people’s experiences of the service. We therefore did not speak with any of these people during this visit.

From discussion with staff, and from reading people’s care records, we found that people needs were fully assessed at the time of their admission. This meant that staff were given adequate guidance on which to base their care of people.

From discussion with staff, and from reading medicine records, we found that prescribed medicines were handled and recorded safely.

We spoke with three of the people who use the service and also observed the way that staff interacted with people. They told us that their privacy was respected and that staff respected their personal preferences. They said staff encouraged them to be as independent as possible and told us, “I can do what I want. It’s a good home.”

People told us they thought their needs were met at the service. However, we found that people’s needs were not always being adequately recorded at the time of their admission. This meant that staff, at times, had little guidance on which to base their care of people.

People felt safe and confident with staff administering their medicines. However, we found that a recording error could have led to compromises in people’s safety.

People felt that staff were competent and one person said they were, “very competent.” They thought the quality of the service they received was good and they felt their views were listened to. One person said that Treetops was, “a good home…very good.” Another told us, “We have [satisfaction] questionnaires once or twice a year [to complete].”

We undertook this inspection on 24 November 2015. It was unannounced. Treetops provides residential care for people with mental ill health and is registered for up to 28 service users. At the time of our inspection 26 people were using the service (though three were in hospital).

Accommodation was provided in a large building in a small village. Due to the size of the home it was covered by staff working in different ‘zones’, there was a lift installed and stairs to separate wings of the accommodation. There was a large activities room which contained a pool table, one large dining room and a smaller dining room. Everyone was accommodated in their own bedrooms. Treetops was registered in December 2011 and was last inspected in September 2014.

At the time of the inspection there was a registered manager in place. 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.

People told us they felt safe and were protected from the risk of abuse or avoidable harm. There were sufficient numbers of staff to meet the day to day needs of people however, staff were not allocated effectively to accompany people on activities outside the home whenever they requested it. A new activities co-ordinator had recently been employed to improve this situation.

Care staff were knowledgeable about the people who used the service and were aware of their roles and responsibilities. They were knowledgeable and skilled in de-escalation techniques to keep people safe from harm.

People were supported to manage their medicines safely.

Staff undertook an induction which included shadowing a more experienced member of staff and they had a good understanding of the requirements of the Mental Capacity Act. Staff routinely sought consent to care and treatment

There were caring and responsive interactions between people and staff and people told us they felt cared for. Staff were aware that everyone living in the home had different needs and wants and they supported them to achieve these where they could. People told us they were treated with respect.

People felt able to complain if they weren’t happy about their care and told us they knew who to approach. The registered manager had a significant presence within the home and was known to people and all members of staff. Quality assurance audits were undertaken regularly but were not always effective in recognising where conditions in the home could be improved upon. This meant that some procedures designed to help ensure protection from, and the control of, infections were not always followed. In addition the home required some redecoration.