Treetops Residential Home

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• 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

We have not provided an overall rating for the key question of safe as we did not assess all the quality statements. The quality statements reviewed at this assessment met the standard of good. People were supported and involved in developing strategies to manage risk. There were enough staff to meet people’s needs, who had received training and support to maintain their skills. Staff had been recruited safely, received an induction, and had their competency checked before they worked independently. Staff understood their responsibility to report any concerns of abuse to the local authority.

This service scored 28 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff and the management team understood their responsibilities under safeguarding. When staff had noted concerns they had shared these with the registered manager who had raised them with the local authority safeguarding team as required. Staff had completed safeguarding training and knew how to identify the signs of abuse. They were confident to raise any concerns they had with the registered manager and providers and were confident action would be taken to keep people safe. Staff comments included, “The providers always say ‘call us’ and they help if I do. They are approachable and always try to help and advise”, “I feel that they would act”, “they would make the effort to do something about it”. Staff knew how to blow the whistle blow outside of the organisation if action was not taken to keep people safe. One staff member told us, “I’m here for the residents”, and they were confident to whistle blow if needed.

We observed staff making sure people were protected from abuse. The registered manager and staff knew how people communicated when they were anxious or distressed and the triggers for these feelings. Staff described to us the action they took to anticipate people’s needs to make them feel as safe as possible and reduce their distress. We observed people did not become distressed during our visit as staff had reduced the triggers for people to reduce the risk.

People felt safe at the service. They told us they were confident to raise any concerns they had with the staff, including the leadership team and were assured they would act. A person told us, “(the provider) has never let me down”. A person told us the leadership team held money for them as “I feel vulnerable with too much money on me”. They told us they were able to access their money when they wanted and spent it as they wished.

There were systems in place to make sure any safeguarding concerns were identified, reported to the local authority and action taken to reduce the risk of incidents happening again. The registered manager maintained a safeguarding log showing concerns which had been raised to the local authority including potential financial and emotional abuse by people who visited the service. The registered manager had worked with the local authority to keep people safe.

We observed the lunchtime meal, people were given meals prepared in line with the dieticians advice. Staff offered people clothes protectors saying “(person’s name) would you like a clothes protector”, the person agreed and staff supported them to put it on. They continued “(person’s name), would you like one”, when the person agreed before putting it on the staff member said “Are you ready”. We observed staff supporting people at their own pace with their meals and drink. They sat next to the person and supported that person only. They checked people were ready for the next mouth full and chatted with them during the meal. We observed meals were prepared to the size people wanted. Some people found a large meal put them off and they were offered a smaller meal which they ate. We observed people sitting with their friends in the lounge and at lunchtime. People chatted together and this reduced their risk of isolation.

People described how they were involved in managing risks. A person told us staff made sure they had small jugs of drink in their bedroom as they found these easier to pour by themselves. “They make sure I get the little jugs and make sure I am happy”. They told us staff supported them to get in and out of bed when they felt unsteady but they went to the bathroom without support. Some people were supported to go out alone. A person told us the provider had purchased them a mobile phone to use while they were out if they were worried about anything. They said this gave them reassurance and they were no longer anxious if they were delayed. They also told us, “I have a home to look forward to when I come back”.

Potential risks to people's health and welfare had been identified and there was guidance for staff to support people safely to mitigate these risks. People had been involved in discussions about risks and how they wanted to manage them. People's decisions were recorded, when they had decided not to take advice from staff and continue with an activity which placed them at risk, staff were supportive. Care plans included information about triggers which caused people to become anxious or distressed. When people had not been able to explain what would help to make them feel safe and calm, staff had spoken to relatives and observed people to develop strategies to support people. The registered manager had recorded accidents and incidents. They had used these to develop plans to keep people safe and reduce the risk of them happening again.

Staff knew what placed people at risk and how to mitigate the risk. For example, they told us one person walked with their head down and did not always see risks ahead of them. The person walked slowly and liked to hold on to a staff members hand for reassurance, this had been effective and they had not fallen. Another person was at risk of falling as they did not anticipate risks when they were walking around the building. Staff observed the person and prompted them to avoid any obstacles. This had been effective and the person had not fallen. Some people were at risk of losing weight or had lost weight. They were offered food fortified with extra calories and were referred to the dietician when this was not effective. One person had been prescribed supplement drinks but did not like them, staff had informed the dietician and requested fortified yogurts as the person often enjoyed eating yogurts. Some people lived with diabetes. Staff had noted one person’s blood sugar levels dropped in the evening on occasions and they were at risk of becoming unwell overnight. They had informed the person’s GP who had changed their medication. If the person’s blood sugar level was below a certain level before they went to bed, staff encouraged them to eat a snack to increase their sugar levels. This had been effective and the person had not become unwell. Staff told us they followed the care plans and had the right equipment to move people safely. They explained how they used slide sheets to reposition people who were cared for in bed and people who were unable to reposition themselves in bed. They described how other people were supported to remain as independent as possible when standing with the support of staff and equipment such as zimmer frames.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff were recruited safely, pre-employment checks were completed before staff started work at the service. The registered manager calculated the number of staff needed to meet people's needs and and reviewed this when people's needs changed. Staff had completed training to develop their skills ensure they could meet people's needs and keep people safe. New staff had received an induction and their competency was checked before they worked independently. Staff had received regular supervision to discuss their role and identify any development needs.

We observed staff spending time together doing activities and chatting. One person worked with the provider to take down the Christmas decorations. Staff spent time chatting to people about each others experiences. For example, they chatted about Christmas in their own homes and cultures, when they celebrated and when they took the decorations down. There were always staff in the communal areas supporting people and chatting to them. Some people spent time with the activities person painting which they enjoyed. Staff gave people reassurance when they were confused and provided support following the guidance within their care plan. One person could become distressed in loud environments but enjoyed classical music. The dining room was busy and we observed the person calmly singing along to the classical music playing.

Staff told us they worked well as a team and communication between them was good and they supported each other. Staff workload was allocated each day and staff knew what was expected of them. One staff member commented that all the staff were professional and were confident to challenge each other about their practice and talk about any shortfalls. Staff told us they had enough time to spend chatting to people and getting to know them and they were not rushed. Staff confirmed they had completed an induction when they started working at the service. A staff member told us, “It’s been really supportive”. A staff member told us the registered manager, “teaches me things”, and this had developed their skills and confidence. Other staff told us they had been supported to complete recognised qualifications in care. The registered manager told us the use of agency staff was rare. They told us, “We can’t have a good service without good staff”. The deputy manager told us, "We have a good team. I can trust them to do what they are asked and to do it properly”.

People told us there were enough staff to provide the support they needed when they wanted it. They told us they got on well with the staff, their comments included: “The staff are like my family”. “They are good they do their jobs really well”. “Staff don’t skip anything when they see to me”. A person told us their support could be a bit delayed in the morning when staff were busy, they commented “I accept that”. “I get looked after properly”. A person told us staff knew what time they like to get up. “They say to me, (person’s name)we’re going to come and wash you now”. “The staff are gentle and don’t pull me about”. Another person told us, “The staff are kind. Friends that serve me with what I need”.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.