Treetops Nursing Home

Treetops Nursing Home is a nursing home providing personal and nursing care for up to 24 older people with dementia or mental health needs. At the time of the inspection, 22 people lived at the service.

People’s experience of using this service and what we found

People were supported with the aid of person-centred care plans which indicated people’s preferences. Staff had time to read these care plans which helped them provide care tailored to each individuals’ preferences. Some details of the care plan needed updating however this did not affect the care to the people. We made a recommendation about this.

People had access to appropriate food and fluids throughout the day however, the dining experience could have been improved to offer people more support to eat and drink. This was highlighted to the registered manager who then reviewed their dining practices in response.

People were supported to live safely at the service with a regular staff team providing care in a positive and caring manner. Relatives provided positive feedback about the service, reporting staff knew their relatives well and offered a variety of activities to promote wellbeing and engagement. One relative described the service as “excellent” with another describing the staff as “fantastic, caring and knowledgeable”.

Staff promoted a positive and respectful ethos throughout the service and understood how to maintain a person’s dignity and offer care respectfully. An open-door policy was also encouraged within the service with both staff and relatives having confidence in the manager to deal with any concerns quickly and professionally.

Systems were in place to monitor the quality and safety of the service to help ensure people received good care. Staff felt supported in their roles and the registered manager was proactive in responding to any feedback to improve the service. The service had good links with other professionals who also reported that the service was well led and reactive to the needs of the people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection

The last rating for this service was Good (published 13 June 2019).

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Treetops Nursing Home is a nursing home providing personal and nursing care for up to 24 older people with dementia or mental health needs. At the time of the inspection, 22 people lived at the service.

People’s experience of using this service:

Staff had a good understanding of people’s care and support needs. Support was provided in a safe way by a consistent team of staff who were committed in ensuring people lived meaningful, fulfilled lives. Relatives provided positive feedback with regards to the service and felt people were safe. Staff were visible around the service and it was clear positive, caring relationships had been developed.

People were provided with support from a team of staff who had the skills and knowledge to carry out their roles. The registered manager encouraged staff to continuously progress. Systems had been developed to ensure people at risk of malnutrition or dehydration were closely monitored. Any accidents and incidents were closely monitored and recorded although a thorough analysis had not always been completed to identify any trends. We have made a recommendation about the analysis of accidents and incidents.

Positive, close working relationships had been developed with other professionals. 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. Choices people made were respected. Where people lacked capacity, appropriate assessments had been completed.

People’s likes, dislikes and interests were carefully considered when planning activities. Staff had the time to spend one to one with people. Care plans were person-centred which ensured support was provided in a consistent way that was led by people.

Systems were in place to continuously monitor and improve the service to ensure people received a good quality service. People were clearly at the heart of the service and regular feedback on the service provided was requested. There was a high level of satisfaction with the all aspects of the service provided.

People and staff spoke positively of the management team. The service was well-run by a registered manager who was passionate about ensuring people received the support they required. The service had good links with the local community and other professionals to promote and improve people’s health.

Rating at last inspection:

Good (report published 9 November 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

Treetops Nursing Home is registered to provide accommodation for up to 24 older people some of whom are living with dementia or who have needs associated with mental health. There were 24 people living at the service when we inspected. The service has several communal areas which include a conservatory and bright, airy lounge. It has a lift, and is fully accessible to wheelchairs. It has specialist equipment to assist people with mobility problems and is close to local transport links.

The service has 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.

Medicines were safely handled and risks were well assessed to protect people.

Staff were able to tell us what they would do to ensure people were safe and people told us they felt safe at the service. The service had sufficient suitable staff to care for people and staff were safely recruited. The environment was safe for people and monitoring checks were regularly carried out. People were protected by the infection control procedures in the service.

Staff had received training to ensure that people received care appropriate for their needs. Training was up to date across a range of relevant areas.

Staff had received up to date training in Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Staff understood that people should be consulted about their care and they understood the principles of the MCA and DoLs. People were protected around their mental capacity.

People’s nutrition and hydration needs were met. People enjoyed the meals. Specialist advice around people’s health care was sought and followed.

People were treated with kindness and compassion. We saw staff had a good rapport with people whilst treating them with dignity and respect. Staff had knowledge and understanding of people’s needs and worked together well as a team. Care plans provided detailed information about people’s individual needs and preferences. Records and observations provided evidence that people were treated in a way which encouraged them to feel valued and cared about.

People were supported to engage in daily activities they enjoyed and which were in line with their preferences and interests. Staff were responsive to people’s wishes and understood people’s personal histories and social networks so that they could support them in the way they preferred. Care plans were kept up to date when needs changed, and people were given opportunities to take part in drawing up their care plans, their reviews and to give their views which were acted upon.

People told us their complaints were responded to and the results of complaint investigations were clearly recorded. Everyone we spoke with told us that if they had concerns they were always addressed by the registered manager who responded quickly and kindly.

The service had an effective quality assurance system in place. Treetops Nursing Home was well managed and staff were well supported in their role. The registered manager had a clear understanding of their role. They consulted appropriately with people who lived at the service, people who were important to them, staff and health care professionals, in order to identify required improvements and put these in place. Records around good governance were clear and accurate and led to planned improvements.

Below is a summary of what we found. The summary describes what people using the service told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary, please read the full report.

This is a summary of what we found.

Is the service safe?

People were treated with dignity and respect by the staff. Safeguarding procedures were robust and staff understood how to safeguard the people they supported. Systems were in place to ensure that the registered manager and staff learnt from incidents such as accidents and incidents. This reduced the risks to people and helped the service to continually improve.

The home had policies and procedures in relation to the Mental Capacity Act (MCA), 2005 and Deprivation of Liberty Safeguards, (DoLS). All staff had been trained to understand when an application should be made, and how to submit one. Documentation was available in people's care files to support this.

Staff had received up-to-date training in all mandatory areas, as well as those specific to their job role. Staff recruitment procedures were thorough and in accordance with the provider's policy. Policies and procedures were in place to make sure unsafe practices were identified and people were protected.

The home had policies in place for the effective control of infection and the environment was clean, tidy and odour free.

Is the service effective?

Staff had the skills and knowledge to meet people's needs. The registered manager gave effective support to staff including induction training, supervision and appraisal. This was supported by a comprehensive training programme. The care home worked effectively with other agencies and health care services to ensure a co-ordinated approach to people's care was achieved.

Is the service caring?

People living in the care home were supported by kind and attentive staff. They were cared for sensitively and given encouragement. People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

The complaints procedure was understood by staff, people living in the care home and their relatives. The registered manager had encouraged relatives to have greater involvement in the care offered.

Is the service well led?

There was a quality assurance process in place. Records showed that any adjustments needed were actioned promptly. This enabled the quality of the service to continually improve. Staff told us they were clear about their role and responsibilities. The staff we spoke to felt they were strongly supported by the registered manager. Staff had received ongoing training in order that they may continue to provide effective care.

We saw that there was a robust system in place for monitoring nutrition and hydration and people were able to access a choice of food and drink at any time throughout the day. The environment was maintained to a good level and the upkeep and repair of all areas of the home was appropriate.

There were appropriate staffing levels in place and sickness and absence were usually covered effectively by existing staff.

The service held resident and staff meetings to gather feedback about the service. Questionnaires were used to gain further feedback. The manager had quality assurance systems in place to ensure that areas such as infection control, medication and care planning were effective and timely.

People who used the service had been asked for their consent regularly, and were able to express their preferences and wishes regarding their care and support. While on our inspection we saw that people were engaged in various activities, and the staff interacted often and positively with people living in the home. One relative told us 'My relative feels very relaxed living here, and is as happy as she can be in a nursing home'.

We looked at records for people using the service and found them to be accurate, up to date, personalised and regularly reviewed. Paperwork was dealt with appropriately by the provider. The service had a robust complaints procedure that was followed effectively. The recruitment and employment of staff was found to be effective and appropriate.