Treetops

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Not all care plans were up to date and contained the correct information for example, ages and GPs. This was discussed with the registered manager who was in the process of reviewing care plans and rectified this immediately. People’s individual needs were assessed, and risk assessments implemented to mitigate any risks identified. Communication care plans were detailed to ensure staff knew how to communicate with people to ensure they are involved in aspects of their care. People and their families were actively involved in care planning. Care plans were personalised and contained lots of informative information about how to meet people’s needs safely and their likes and dislikes. Referral to other services were made in a timely manner. People attended their health appointments with the support from staff if appropriate. Information was shared between staff during daily handovers and communication records to ensure all relevant information was shared. Staff told us they were involved in care plan reviews and other services and agencies were involved in the care of people. Staff received training relevant to peoples needs to ensure they could support people safely and had the right skills and knowledge. Compliments and complaints were logged and acted upon. A home development plan highlighted annual objectives for the service, which included a consistent approach to goal setting and activity planning with people.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People or their advocate were involved in care planning before moving into the service. Feedback provided demonstrated people were actively involved in their care plans and reviews as and when they were required. Care plans were person centred and evidenced involvement of people using the service and their experiences.

Staff told us that people and their families were always included in assessment and care planning. Staff told us that assessments are up to date and staff are aware of the individual needs of people. For example, communication needs for each person are taking in to consideration. For some people, pictures are used to communicate and these are available around the home and also documented in care records. The manager told us that there is a process in place to assess people before they are accepted or admitted to the home. The process includes evaluating the needs of the person and ensuring that appropriate measures and staff were in place to be able to meet those needs. The manager outlined some concerns with regards to lack of information being provided by local authorities which can impact the placement in the long run. Staff told us that regular meetings are held about people which included involvement with families and external agencies involved in their care. Staff told us there are a mixed skill set of staff on each shift and the shift is planned out at the beginning of the day for example – somebody who is Buccal trained, first aider, fire marshall etc. The manager told us that communication needs are regularly assessed for example, one person is awaiting a SALT assessment however until that happens, staff are encouraged to continue using PEC cards.

Risk assessments were in place and were specific to meet people’s needs. Care plans evidenced involvement of people using the service and their family members. However, some contained other people’s names and some details had not been updated following a review, this was discussed with registered manager who was in the process of updating them. Staffing levels were reflective of peoples needs to ensure people were supported safely by qualified and skilled staff. There was evidence meetings were held with other professionals to meet the needs of people living within the service. Mental Capacity Assessments and Best Interest decisions were completed in line with the Mental Capacity Act 2005 to ensure all decisions were completed in the persons best interest and in the least restrictive way.

Feedback we received evidenced people and their family members were involved in ensuring their health needs could be met. Observations demonstrated people were provided with a choice of what meals they wanted and had access to fluids when required.

Staff told us that people are weighed on a regular basis. Staff told us that if somebody was overweight or underweight, they would support them appropriately for example, one staff member told us ‘I would support the person to make healthier choices at mealtimes and follow any meal plans that are already in place’. Another staff member told us they ‘promote healthy eating and exercise. Staff were able to recognise how diabetes can impact weight and told us that the diabetes nurse also supports with this. Staff told us they follow PBS plans as a guide in knowing how to best to support people but will also ask the person involved

Some staff have had training in line with best practice and skills for care. However, there was outstanding training for some staff including care certificate, Oliver McGowan training, Epilepsy awareness and diabetes awareness. Specific risk assessments were in place for example, a diebetic risk management plan for one person provided an explanation of diabetes, the impact on that person and how this should be monitored by staff. A Buccal Midazolam care plan was in place for another person which described the seizures, duration and treatment plan.

People and their families told us they were supported to hospital appointments when needed. Extra support was provided to ensure people attended appointments with staff that new them well. Family members were kept up to date with any appointments and with consent information was shared with them.

Staff were able to identify where risk assessments, care plans and PBS plans are kept and have access to these at any time. Staff told us they complete handover forms, daily diaries and have daily handover meetings to ensure that information is shared between different shifts. Staff told us that other services and agencies are regularly involved in the care of people; multi agency meetings are held regularly to share information. The manager was able to explain the pre admission process and checks which are complete prior to any individual being placed in the home. This involved assessing risks, ensuring needs could be met and discussing the referrals at a panel.

Feedback received from partners was positive, they felt staff worked well together to meet the needs of the people. This included the management team.

Daily handover took place however, due to shift patterns not all staff could attend therefore a communication book was in place to ensure all information was shared with staff members. There was evidence referrals to other services were made this included podiatry, GP and opticians and dentists. Care plans were reviewed however they were not always updated in a timely manner to reflect any changes in peoples care needs. The service ensured staff feedback was sought and there was evidence of team meetings. We viewed minutes of team meetings and identified open discussions took place and any actions identified, all staff were involved in complying the action plan.

We observed numerous activities taking place. People were encouraged to participate in activities of their choice. For people who struggled with communication there was evidence information of people’s likes and dislikes were sought from family members and other professionals. PEC cards were utilised to ensure people who experience communication difficulties could be involved in decision making about things they wanted to do.

Staff told us they encourage all people to make healthier choices in relation to diet and encourage all people to exercise daily even if this is just going for a walk.

Care plans were detailed in relation to people likes and dislikes. Photographs and displays throughout the service evidenced people were actively supported to engage in activities. Positive risk taking was supported with appropriate risk assessments in place.

People’s care plan evidenced they were involved in discussing their goals and wishes. Family members were happy with the care their loved ones was receiving and had seen an improvement in their level of engagement and positive interactions.

Staff told us that they are aware of people’s wishes and goals for support by reviewing their care records and PBS plans. One staff member told us that alongside this, she would also ‘follow the lead of the individual and offer choices’. Staff could also explain how this differs between people with different communication needs and recognise some people’s needs based on reactions around certain situations or activities.

Care plans were in place for people that were supported however some of these had blank action plans. Compliments and complaints were logged and acted upon. A home development plan highlighted annual objectives for the service, which included a consistent approach to goal setting and activity planning with people.

People who did not have capacity to make an informed decision family members told us they were consulted as part of the process. PEC were utilised to ensure people who had difficulties in communication could still make choices.

Staff told us they had received training in the Mental Capacity Act 2005. Staff told us that they made sure they asked people for consent before supporting the person. One staff member said ‘we offer choice and always ask the person what they want for example, ask if they want a bath.’ Staff would inform people of what they were about to do. Staff were able to explain what they would do if people refused care. They were able to relate this to decisions, involving family and in some cases making a best interest decision on behalf of a person, if they lacked capacity.

There was a DOLS process in place. Those who require a deprivation of liberty safeguards either had these in place or had been applied for. There was evidence of support from the advocacy service for those people who required additional support.