Three Trees

Three Trees is a residential care home providing accommodation and personal care to 16 people with a learning disability and/or autism at the time of our inspection. The service can support up to 21 people.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support: The service was not always delivering a model of care that maximises people’s choice, control and independence. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People did not have care plans which focused on goals and skill setting. There was no evidence of future planning for people.

Staff enabled people to access specialist health and social care support in the community. We received positive feedback from visiting professionals regarding guidance being followed to achieve better outcomes for people’s health needs. Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome. Staff supported people to play an active role in maintaining their own health and wellbeing.

Right Care: People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough appropriately skilled staff to meet people’s needs and keep them safe. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs.

Right Culture: The governance systems in place were not effective and we found documentation was poor. People’s care plans were not always reflective of their current needs and didn’t include enough information to guide staff on how to mitigate specific risks.

People received good care and support because staff could meet their needs and wishes. Staff turnover was very low, which supported people to receive consistent care from staff who knew them well.

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 and update

The last rating for this service was requires improvement (published 1 May 2020) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended that provider reviews their process of formal support to staff. At this inspection we found the provider had made improvements in this area. Staff told us they felt supported and there was evidence of regular formal supervision.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has not changed from requires improvement based on the findings of this inspection. You can see what action we have asked the provider to take at the end of this full report.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Three Trees on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to the need for consent, failure to notify CQC and governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Three Trees is a residential care home providing accommodation and personal care to 18 people with a learning disability and/or autism at the time of our inspection. The service can support up to 21 people.

The service was designed prior to Registering the Right Support and other best practice guidance being implemented. This means that it does not meet current best practice around the size and number of people living together. However, the large building did have three distinct separate units where people had access to their own lounges and dining/ kitchen areas. People spent more time within the large communal areas through choice as they had lived at the service for many years.

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

The service didn’t always apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons, people were not always supported to access individualise leisure and recreation. Further work was required to ensure people’s care and support was designed and delivered in a personalised way to enable them to achieve good outcomes. The registered manager needed further understanding of Registering the Right Support.

Systems and checks to monitor the quality of the service were not always effective. The checks in place had failed to identify and address areas we found at this inspection. Records were not always accurate and fully completed.

Lots of people were supported to access the community independently. However, for people who needed support there was limited opportunity. Care staff carried out social activities alongside their caring duties; this limited the amount of dedicated activity provision available. We have made a recommendation about the activity provision available to people.

Recruitment checks were carried out, but records were not always completed or detailed. Staff told us they received induction and support. Records were not always completed for induction and new staff did not always receive formal supervision. We have made a recommendation about formal staff support.

People received their medication as prescribed. Some medication records and staff competency assessments were not always completed. People were supported to attend health care appointments. However, advice and outcomes from appointments was not always recorded.

Some areas of the service required attention, such as decoration and replacement of furniture.

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.

People’s nutritional needs were met. People were happy with the food and drinks available. They had the opportunity to access kitchens independently to prepare drinks and snacks.

People told us they felt safe at the service and with the support they received from staff. They were supported by kind and caring staff, who knew them well.

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

Rating at last inspection

The last rating for this service was good (published 19 September 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to governance of the service at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection in April 2015 the service was rated as Good. At this inspection we found that the service remained Good.

There continued to be sufficient numbers of staff employed to make sure people received the support they needed, and those staff had been safely recruited.

Staff continued to receive appropriate training to give them the knowledge and skills they required to carry out their roles. This included training on the administration of medicines and on how to protect people from the risk of harm.

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

People led active lives; they attended day centres and took part in activities within the home and in the local community.

Staff were kind, caring and supportive and they respected people’s privacy and dignity.

Care planning described the person and the level of support they required. Care plans were reviewed regularly to ensure they remained an accurate record of the person and their day to day needs.

People told us they were aware of how to express concerns or make complaints. People were also given the opportunity to feedback their views of the service provided.

The manager carried out audits to ensure people were receiving the care and support that they required, and to monitor that staff were following the policies, procedures and systems in place.

The feedback we received and our observations on the day of the inspection demonstrated that the home was well-led.

After the comprehensive inspection, the registered provider wrote to us to say what they would do to meet the legal requirement in relation to the breach. We undertook an unannounced focused inspection on the 21 December 2015 to check that the registered provider had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this one breach of legal requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Three Trees’ on our website at www.cqc.org.uk

Three Trees is a care service that is registered to provide accommodation and personal care for up to 21 people. People who live at the service have a learning disability or autistic spectrum condition.

At the time of the inspection there was a registered manager in post in the service. 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. In addition there was also a care manager in post. They were employed to assist with the day to day running of the service and are referred to in the report as the manager.

At our focused inspection on the 21December 2015, we found that the registered provider had followed their action plan in which they had told us they would be compliant by 18 September 2015. We found that sufficient improvements had been made to the way that staff administered medicines that we judged that the breach in regulation had been met. The registered provider had revised their medicine policy and procedure and ensured all staff responsible for medicine administration had seen and read the new policy and procedure. Changes to the way staff administered medicines had been made in line with best practice, and these changes were reflected in the new medicine policy and procedure.

We observed that people who lived at the home were supported to be independent and to make their own decisions about their day to day lives. Efforts were made to ensure that people consented to the care and support they received from staff.

People who lived at the home were encouraged to take part in activities, both within the home and external to the home. Care plans recorded a person's capabilities and how they wished to follow their chosen lifestyle. We saw that risk assessments supported responsible risk taking and recorded how any identified risks would be managed. We observed good rapport between people who lived at the home and staff and that a homely atmosphere was promoted.

We saw that staff were recruited safely although we noted that the policies and procedures in place could be more robust. There were sufficient numbers of staff employed to provide safe levels of care and enable people who lived at the home to take part in their chosen activities.

There was a quality assurance system in place that included obtaining the views of people who lived at the home and staff. Regular audits were undertaken to monitor the quality of the service provided and to check that systems introduced to promote safe practices were being adhered to.