Tree Top View

Updated 8 February 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

This inspection was conducted by one inspector.

Service and service type

Tree Top View is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

The first day of the inspection was unannounced. The second day of the inspection was announced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.

During the inspection

We spoke with 12 members of staff including the registered manager, operations manager, the positive behavioural support practitioner, deputy manager, senior care workers, care workers, the house keeper and skills for life co-ordinator. We observed the support people received to help us understand the experience of people who could not talk with us. We looked at secure online videos and photographic evidence of people engaging with activities and daily life skills. We reviewed a range of records. These included two people’s care records and multiple medication records. We looked at one staff file in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were also reviewed.

After the inspection

We spoke with six relatives who provided feedback about the experience of the care provided. We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with three professionals who regularly visited the service.

Updated 8 February 2020

About the service

Tree Top View is a residential care home providing personal care to five people at the time of the inspection. The service can support up to six people between the ages of 18-65 with learning disabilities and autism. There are six ensuite bedrooms with shared communal space. There is a separate building adjacent to the main house that contains a small gym, an education room, laundry facilities and staff offices.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

People received an exceptional standard of person-centred care and support which enabled them to experience positive outcomes. This was because the service applied the principles and values of Registering the Right Support and other best practice guidance including Positive Behaviour Support (PBS). PBS is an approach used to understand the behaviour of an individual. It is based on an assessment of the social and physical environment in which the behaviour happens, includes the views of the individual and everyone involved, and uses this understanding to develop support that improves the quality of live for the person and others who are involved with them. These principles ensured that people who used the service could live as full a life as possible and achieve the best possible outcomes that include control, choice, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

We received extremely positive feedback about the service people received, comments centred around how well the service was led, social inclusion and person-centred care. Relatives told us, “Tree Top View supports each [person] on an individual basis, and with person centred planning. The managers and experienced dedicated senior support staff build up a programme of activities that suits preferences as well as needs. Loved ones are fully supported by the service and parents are included throughout the personalised journey to discover the needs and likes of each resident, the result of which provides a safe, happy and stimulating environment for residents to live, learn and enjoy life in” and “Staff are kind, caring and have the right attitude.”

Staff truly embraced a holistic approach to supporting people in a person-centred way by undertaking thorough assessments of their needs and taking time to understand their preferences, keeping them at the heart of all assessments. Staff received training by the organisation which was person-centred for their needs as well as of those they supported. Staff told us they were supported and the registered manager went over and above to ensure they were safe and happy at work.

The service was exceptionally managed by a team of skilled and co-ordinated staff. The registered manager invested in staff’s professional growth to ensure in their absence the service continued to sustain outstanding outcomes for people. Stakeholders consistently told us about the positive changes to the culture and staffing since the registered manager took over. The registered manager was innovative around staffing and recruitment and they had undertaken a piece of work around agency staff consistency including agreed terms with agency providers for temporary to permanent employment, this ensured candidates were right for the job.

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. The senior management team were asked to participate in a steering group with local commissioners to share best practice around restrictive practices. Professionals told us staff were respected for their knowledge and commitment to PBS.

People had achieved significant and life changing positive outcomes since the last inspection. Staff genuinely cared for people and their relatives. There was a clear inclusive culture. Staff were passionate about making a difference to people’s lives and helping them to achieve their goals and challenge their abilities.

People were protected from abuse and avoidable harm. Staff understood about positive risk taking, reporting risk. People’s medicines were managed in a safe and person-centred way. The environment was clean and refurbishment plans had been approved to improve some areas of the environment.

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 16 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.