Treetops

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Medicines were not always clearly documented in one central place, there were multiple sheets to record the information on which made it difficult to understand. This was brought to the registered managers attention who took steps to rectify this. Temperature recordings for the medication fridge had not been recorded for a few days due to the thermometer not working. The registered manager ordered a new thermometer during day 2 of the site visit. There were concerns over the administration of medicines, the registered manager addressed the concerns and ensured all staff were assessed as competent. People and their relatives felt safe. They were able to raise concerns if they felt necessary. Safeguarding policies and procedures were in place and staff were aware of how to raise a concern. Staff were aware of their roles and responsibilities to safeguard people from abuse. Safe recruitment systems were in place and were being followed to ensure people were safely recruited and suitably qualified and trained to provide safe support.

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 and their family told us they were confident in raising concerns if they needed too. When concerns have been raised, actions have been taken and people were provided with feedback. People felt safe and listened too. We saw evidence meetings took place and feedback was sought from people who lived in the service and their families.

Staff told us they were happy to speak up and report any issues to their manager. They felt able to contribute to team meetings and make suggestions for improvement. Staff felt listened to and supported by their manager. Staff told us that learning from incidents was fed back via team meetings and supervisions.

Complaints procedures and whistleblowing policies were available and displayed within the service. There was evidence complaints and incidents were responded to and recorded as required.

People and their relatives were happy with the support they received. Feedback demonstrated referrals were submitted to health professionals when required and support was offered to attend appointments. People were encouraged to participate in activities of their choice. Photographs within the service evidenced a wide range of activities that people living within the service undertook.

Staff told us they felt they had enough training to enable them to do their jobs effectively. They understood what their roles and responsibilities were. Staff told us they had received training to enable them to support the needs of the people who use the service for example learning disability and autism training. However, some staff told us that they did have some training outstanding e.g. Buccal training which would impact the support they could offer to some people. Staff were aware of people’s dietary needs and wishes and told us that these were also documented in Positive Behaviour Support plans and care records.

Feedback from partners was positive, we were told when concerns were identified in relation to the placement of people within the service, the registered manager and staff went above and beyond to provide additional support to keep people safe.

The service told us before people moved into the service a robust assessment process takes place including face to face assessments, information from the Local Authorities and meetings with the providers own risk enablement panel. Multiagency meetings were held regularly to ensure support provided was tailored to each individual’s needs. The service worked closely with specialist services to ensure staff had appropriate training to support people's needs within the service. When people’s needs changed the service ensured staff received additional training to meet their needs.

People we spoke to felt safe living within the service and were happy with the support they received. They told us they were able to speak to the registered manager and other staff if they needed too. People living in the service had been given the opportunity to complete their safeguarding training which promoted independence and raising awareness of abuse.

Staff had a good understanding of safeguarding and how and who to report to if they had concerns about the safety of a person. All staff told us that they had completed safeguarding training and training around the Mental Capacity Act. Staff felt confident that appropriate action would be taken by their management team if any safeguarding concerns were raised. One staff member stated that he would report to CQC if he felt appropriate action wasn’t being taken. Staff said they would feel able to whisteblow if necessary. Staff were able to name the residents who were subject to DoLs and were able to explain the impact this has on their care and support. Staff stated that they had access to the safeguarding policy and knew where they would find this.

We observed staff supporting people safely ensuring risks were managed.

There were systems in place to safeguard people from abuse. This included safeguarding, MCA and DOLS policies and procedures. Incidents were recorded and reported to the relevant authorities when required. Most staff had completed safeguarding training and for those staff who had not completed it plans were in place to ensure they were given protected time to do so.

People and their relatives told us they were involved in managing their own risks. We saw evidence people who self-medicated were involved and assessed in devising their own risk assessment.

Staff knew people very well and understood the risks to people. Staff had a clear understanding of risk management and how to mitigate risks. When asked about risk assessments, one staff member said ‘risk assessments are constantly changing and being updated. Each day presents a different risk. We assess risk on a daily basis.’ Staff told us they had access to people’s risk assessments and were aware they were kept in people’s files. They also told us that PBS plans are in place for each person and kept in their files. Staff reported to have received ‘Passport training’ (a course which focused on understanding positive behaviour support practices). Staff stated that they would always use the least restrictive practices and could name some examples.

We observed staff using the least restrictive practices in line with people’s Deprivation of Liberty safeguards (DoLs) and Mental Health Act (MHA). For example, the kitchen was only locked when cooking was in progress for the safety of a person. At all other times, the kitchen was left unlocked. We also observed staff members managing risk efficiently for example, the manager went for a walk with one person who was reportedly feeling low. We observed a handover meeting between shift changes – this allowed staff to handover any concerns, risks, or actions.

Risk assessments were up to date for each person including specific risk assessments individual to each person; these included eating inedible objects, head injury, hoarding and diabetes. All risk assessments and plans in place for each person were acknowledged and signed by staff to confirm understanding. In the care records of two of the people under DoLs, all relevant paperwork was visible – the DoLs application, balance sheets, MCA assessment, consent forms, court of protection. Care records contained a lot of detailed information however some of the information was outdated or inaccurate for example, a wrong age was stated in one care record and a wrong name was stated in another care record. It was difficult to locate important documents such as risk assessments and care plans in care records due to the volume of information. The registered manager stated that she was already aware of these issues and was in the process of streamlining the care records to contain the most relevant and up to date information. Some care plans were lacking in information and action plans were blank. Each of the care records viewed were person centred and included a PEN profile, personal support plan, activity plan, motivational inventory exploring likes and dislikes, PBS support plans, end of life care plans. Restrictive intervention reduction and elimination plans were seen in care records which identified risk, in what way restrictions apply and how welfare, dignity is maintained. Completed daily records for people included food and fluid charts.

People were happy in the environment; one person told us they wanted repairs to be completed. This was discussed with the registered manager who had identified repairs that were required in the home and was in the process of ensuring these were completed.

Staff knew how often fire drills and fire alarm tests took place. They reported knowing where fire exits were and signing in and out of the building. Staff informed us that first aiders, fire marshalls and those who are specifically trained in Buccal for example, are identified at the beginning of every shift. The manager told us that rotas are amended according to the needs of the service. The manager told us that they have made adaptations to a bedroom to suit the changing needs of a person whose health has declined.

Window restrictors were in place in all upstairs rooms, wardrobes were attached to walls in bedrooms and fire doors were kept closed. We observed damage to flooring and banisters however we were assured that these jobs were scheduled to be complete. A job list was provided from the registered manager which confirmed this. People’s rooms were designed to mitigate any risks to ensure peoples needs could be met safely. We raised issues with the staff smoking area due to risk of smoke inhalation from residents who do not smoke. This was addressed and rectified on the second visit. We were informed of peoples individual risks when we arrived at the home.

All relevant maintenance certificates were up to date including gas safety certificate, electrical wiring certificate and legionella certificates. Action plans from fire risk assessments and gas safety certificate had been complete and evidence was provided to support this. PAT testing had not been complete however regular visual checks of electrical equipment are complete and recorded. Records of daily checks were seen including fire safety checks, water temperature, fridge/freezer. Fire safety signage is displayed around the building. Fire evacuation drills occur monthly and alternate between day and night. These are all recorded along with any actions. Monthly fire extinguisher checks are complete. Business continuity plans are in place which include response to severe adverse weather, utility failure, building and equipment problems. Mitigating actions are documented. All staff have had first aid training, fire awareness, COSHH and food safety training.

People told us they thought there was enough staff to support them safely. On relative told us, “the staff seem to care and not just doing it for money.” People spoke highly of the staff and the management team. People said staff were approachable and understanding.

Staff reported that there are always appropriate staffing levels in the home and a skill mix to ensure that people are supported effectively. One staff member said ‘staffing levels are never an issue’. Staff reported cover of an evening and weekend was also appropriate. Staff reported that levels of staffing can change based on level of need and residents that are at home. If ever there was not enough staff on a shift, it was reported that the team are very supportive and will often pick up extra shifts, as opposed to using agency staff. Staff were happy with the level of training and support that they received for their role. They were aware of their roles and responsibilities. Staff reported that training was ongoing and they were regularly being upskilled. Staff told us that they receive regular supervision and feel confident to be able to raise any issues with their manager. However, this was not corroborated by supervision records and was not in line with company policy. Staff stated that they were unsure of or had not had an appraisal.

We observed a high level of staffing within the service. Staff were visible in all areas of the home. There were concerns regarding staff eating in communal areas however the registered manager addressed this immediately and staff were provided with facilities to make their own dinner in the staff room.

Safe recruitment systems were in place. Checks were made with the Disclosure and Barring Service (DBS). There was a 4wkly rota in place to ensure there was adequate staffing to meet the needs of people living within the service and to ensure people were able to access the community and participate in activities of their choice.

People felt the home was clean however it required some maintenance.

Staff told us that they have completed online training in IPC. One staff member told us that she has been observed washing her hands. Staff told us they have access to PPE and there is plenty all around the home in every room, kitchen and bathrooms. The registered manager told us that competency assessments are completed for staff during induction and spot checks thereafter.

We observed staff members using gloves and changing gloves when handling medication. Hand sanitiser and soap was available around the building. Posters throughout the service displayed the handwashing process.

Risk assessments for people include COVID-19 and the use of PPE. Cleaning logs were in place for all rooms in the building however there was some gaps where cleaning had either not been completed or not been recorded. The cleaning logs also included a section on infection control – checking soap/hand sanitiser, paper towels and masks. There was also a night time environmental cleaning record sheet in place which was colour coded to inform staff of what colour cloths to use on what areas. All staff have received training in COSHH, fire awareness and infection and prevention control. There is an IPC policy in place which outlines for example, the use of PPE, personal hygiene and health, waste disposal, standard precautions. IPC audits are complete on a monthly basis – the last 2 audits were viewed and were both scored at 100%.

People received their medication as prescribed. For people that are able to self-medicate, appropriate risk assessments were in place including observation records. People were able to request medication when they required it.

Staff told us they had received training in medicines management and competencies have been checked. Staff were able to explain what the process is if a medicines error occurs.

There was a medication policy was in place. Most staff had completed their level 2 and 3 medication training. Where a staff member had not received appropriate training, the service ensured there were suitable qualified staff within the home at all times. Staff’s competency to administer medication was completed. Medication was safely stored however during the assessment the fridge temperature had not been recorded due to the thermometer breaking, this was rectified. The recording of medication was difficult to understand due to the duplication of recordings, this was discussed with the registered manager and plans were put in place to rectify this.