Twelve Trees care home provides care and support for up to 34 older people, some of who are living with dementia. There were 28 people living at the service when we visited.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

The home had a manager in place who had applied for registration with The Care Quality Commission (CQC). 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.

Staff knew how to protect people from the risk of abuse or harm. They followed appropriate guidance to minimise identified risks to people's health, safety and wellbeing. There were enough staff to keep people safe. The provider had appropriate arrangements in place to check their suitability and fitness to support people.

We saw people were supported to have sufficient to eat and drink to maintain a balanced diet. People told us they liked the food and lunchtime was a social event.

The environment was clean and staff followed good practice for minimising risks to people that could arise from poor hygiene and cleanliness. They also ensured the environment was clear of slip and trip hazards to support people to move freely around. The premises and equipment were regularly maintained and serviced to ensure these were safe. Medicines were managed safely and people received them as prescribed.

People's rights were also protected because management and staff understood the legal framework of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). We saw staff had received refresher training in the last two years. In addition, we also found staff had received formal supervision and appraisal.

The manager and staff ensured access to healthcare services were readily available to people and worked with a range of health professionals, such as social workers, community nurses and GPs to implement care and support plans.

People were involved in the assessment and care planning process and their care plans were regularly updated to reflect their changing needs. People were encouraged and supported to participate in a range of activities to suit their individual interests. There was a complaints system in place and people felt able to raise any complaints or concerns.

Staff were respectful and compassionate towards people ensuring privacy and dignity was valued. People were supported in a person centred way by staff who understood their roles in relation to encouraging independence whilst mitigating potential risks.

Systems were in place to make sure people's views were gathered. These included regular meetings, direct interactions with people and questionnaires being distributed to people, relatives and healthcare professionals. The service was assisted to run effectively by the use of quality monitoring audits carried out by the manager and registered provider, which identified any improvements needed and actions were taken.

This inspection was unannounced and was undertaken on 26 January 2015.

Twelve Trees was last inspected by the Care Quality Commission (CQC) in January 2014 and was found to be meeting regulations relating to respecting and involving people who use services, care and welfare of people who use services, cleanliness and infection control, staffing and complaints.

Twelve Trees Residential Home is a large converted Victorian house which provides accommodation for up to 34 people who require nursing or personal care. There were 28 people living at Twelve Trees Residential Home at the time of this inspection, some of whom were living with dementia.

There are 26 single en-suite rooms and 4 double en-suite rooms. Accommodation is provided over three floors, accessed by a lift. Shared, adapted bathrooms are situated throughout the home. The home has two lounges and two dining rooms.

A registered manager was 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 that they felt safe living at Twelve Trees Residential Care Home. We found that there were sufficient staff to meet people’s needs and keep people safe. Conversations with staff and the registered manager demonstrated that they were aware of local safeguarding procedures and had the necessary knowledge to ensure that vulnerable adults were safeguarded from abuse.

People told us that they received their medicines on time. Our observation of part of one of the medication rounds together with our review of records provided evidence that medicines were safely administered, recorded and stored.

There were sufficient care staff to meet people’s needs. Staff were aware of people’s nutritional needs and food preferences. Our informal observations of mealtimes, conversation with the cook and our review of nutritional records evidenced that people received a choice of suitable, healthy, homemade food and drink.

Conversations with staff and observations throughout our visit showed us that staff offered and involved people in a range of day to day decisions. The registered manager demonstrated a clear understanding of the requirements of the Mental Capacity Act, 2005 (MCA). Whilst our observations evidenced that staff followed the principles of the MCA, our conversations with staff demonstrated a lack of knowledge about the important elements of the actual Act and how these related to their practice. For example, whilst staff told us that they had heard of capacity assessments and best interest decisions, they were unable to explain these key parts of the Act.

There was a lack of appropriate directional signage in some areas of the home to orientate and support people living with dementia to locate key areas of the home.

Staff received regular supervision and an annual appraisal. Staff were positive about the training courses they received and the further training courses they were encouraged to undertake. We found that some staff had not received courses relevant to the needs of people who used the service for a number of years. For example, some staff had not received dementia training since 2008 and 2009.

Our observations together with conversations with people, health professionals and relative provided evidence that the service was caring. We saw that staff across the home had a good understanding of people’s individual needs and preferences. Staff knew how to respect people’s privacy and dignity.

People’s physical health needs were monitored and referrals were made when needed to health professionals. The registered manager and staff spoken with during our inspection were proud of the end of life care they provided to people. This was further demonstrated by our conversation with the home’s GP who describe end of life care the home provided as, “Excellent.”

The home was proactive in providing activities and experiences to meet people’s differing needs and preferences. People were supported to continue to attend the groups and clubs they enjoyed prior to living at the home and to maintain existing community links.

Staff were positive about the registered manager and the way in which she led the service. They told us that the registered manager was always around and was approachable and proactive in trying to make the service as good as possible.

A range of regular scheduled and unscheduled checks were undertaken to monitor the quality of the service. People, their friends and family and visiting health professionals were encouraged to give feedback about the service.

This unannounced inspection took place on Sunday 26th January 2014. During our inspection we spoke with four people who used the service, one of whom told us, “It couldn't be better everybody is so obliging”. Another person stated, “I'm happy here and I always get things if I need them.”

There was a calm and relaxed atmosphere during our inspection. We observed staff treating people in a kind and gentle manner, offering assistance where required and sitting with people engaging in eye-to-eye contact.

We heard examples from people and their relatives about how staff at Twelve Trees offered choice and respected people’s dignity and privacy. For example, one person told us, “I have my meals in my room as I don't like going to the dining room all the time."

During our inspection, we were able to speak to one relative. They told us that they were confident in the way in which their relative was cared for, and that they were informed straight away of any issues about their relative’s care.

We noted dedicated members of staff were seen carrying out cleaning duties throughout the home during our inspection. There were effective systems in place to reduce the risk and spread of infection.

We spoke to four members of care staff. Comments included "Brilliant, this is a lovely place to work." "I really like it here." and "the staff are wonderful to work with and it's a joy to work here."

We looked at Twelve Trees training matrix and saw that this detailed a range of mandatory and other training sessions. The four members of care staff we spoke to confirmed that they had received a variety of training.

We spoke to four people who told us that if they had a complaint about their care they would talk to their key worker or the manager. They told us all staff were approachable and people would have no hesitation in talking to them.

We spoke with four people about how the service respected and involved them in life at Twelve Trees. One person stated, “the staff are very kind, they always get things if I need them.”

People were positive about activities offered by the home. A number of people told us about their enjoyment of visits from ‘pets for therapy’ and various entertainers.

We heard examples from people and their relatives about how staff at Twelve Trees offered choice and respected people’s dignity and privacy. For example, one person told us, “I like to have my breakfast in my room, carers always knock on the door before they bring it into me”, and that, “the carers know the time of my afternoon nap and never disturb me.”

We spoke with four relatives about how the service respected and involved their family member. Each relative described staff within the home as “kind.” One relative told us that their family member had some communication difficulties. They told us that the staff at Twelve Trees, “understand [their] needs and wants” and, “always talk and explain what they are doing, it makes [their] face light up.”

People we spoke with and their relatives told us that the home did not have any residents or relatives meetings, or hold meetings to specifically discuss their care plans. People who used the service and their relatives did not see this as an issue. They told us that both the manager and owner of the home were visible and that they felt able to discuss any issues with them. Relatives were positive about the fact that the home always kept them informed about any medical visits and appreciated the fact that the home regularly phoned to update them and inform them of any changes to their relative’s care.

We spoke with three people about the care, treatment and support they received at Twelve Trees. One person told us, “it’s so lovely living here; it’s nice to know that the staff really care for me and are concerned about me.” Another person stated, “I’m quite happy here, it’s a home from home. The staff are very good and very helpful. I’ve no complaints at all.” The same person also told us that, “staff are soon here if I use the buzzer.”

We spoke with four relatives in order to gain their views of the care, treatment and support received by their family members. Each relative told us that they were confident in the way in which their relative was cared for, and that they were informed straight away of any issues about their relative’s care. One relative told us that they never tell the home of when they intend to visit and stated, “things are always the same whenever I visit. I cannot rate the care [my relative] has received highly enough, nothing is too much trouble for any of the staff.”

People told us that they felt safe living at Twelve Trees. One person stated, “staff always keep having a look around to make sure that everyone is safe.”

Relatives also felt that their family members were safe living at Twelve Trees. One relative stated, “I’m grateful to know that I can leave my visits knowing that [my family member] is safe and looked after.”