Dove Tree House

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At this inspection we found the service remained Good.

Why the service is rated Good

We carried out an unannounced inspection of Dove Tree House on 3 December 2018. Dove Tree House provides care and accommodation for up to 34 people who required accommodation and personal care. Nursing care can be provided through the local community nursing services if appropriate. At the time of the inspection 34 people were living at Dove Tree House.

There was a registered manager who was clearly passionate about providing a good quality service and aimed to support people to have the best life they could. 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. The provider, Stonehaven (Healthcare) Ltd, is part of Stonehaven Care Group which is a family run company providing care in eleven homes throughout the South West. Each home was supported by a central support office and a director visited each home at least once a month to monitor quality standards.

On the day of the inspection there was a calm and relaxed atmosphere in the home and we saw staff interacted with people in a friendly and respectful way. People were able to choose what they wanted to do and enjoyed spending time with the staff who were visible and attentive. There was a lot of staff interaction and engagement with people, some of whom were living with dementia and unable to tell us directly about their experiences. They looked comfortable and happy to spend time in the large and homely communal areas.

People and relatives said the home was a safe place for them to live. Without exception people, staff and visitors all said how lovely the home was. People commented, “This is a special place, we have good chat”, and “It’s wonderful. I’m very safe, it’s the staff that make it, we are friends and it’s my home.” They had given the registered manager and staff a lovely Christmas card. Another person had called their soft toys after staff members and the registered manager cherished items made for them during art and craft sessions by people.

Staff said, “It’s wonderful here. I love it. We work as a team and we love the people. It’s the people that make it, we are all relaxed, all friends. You come to work and its so lovely.” The registered manager was knowledgeable and knew all about each person as an individual and said, “We see everyone as our family too. It’s often their last home so we make it a good one.” For example, staff thought about people when they were not working, bringing items to share from holidays or shopping trips. The registered manager had noted that one person loved their perfume so had got them some.

Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns. Staff were confident that any allegations made would be fully investigated to ensure people were protected. Any safeguarding concerns had been managed well with provider involvement and the service worked with the local authority safeguarding team. Relatives said they would speak with staff if they had any concerns and issues would be addressed and people living with dementia seemed happy to go over to staff and indicate if they needed any assistance. Staff were vigilant about protecting each person from possible negative interactions with other people living at the home, recognising frustrations and misunderstandings between people due to them living with dementia. They used chatting and distraction techniques as they knew people well, showing patience and understanding.

People and relatives knew how to make a formal complaint if they needed to but felt that issues would usually be resolved informally. There had been few formal complaints, the last formal complaint in 2016. The office had an open door policy and visitors, people and staff popped in throughout the inspection.

People were well cared for and relatives were involved in planning and reviewing care as people wished or were able. Care plans were electronic and very personalised showing that people were cared for in the way they wanted. They were enabled to make smaller day to day choices such as what drink they would like or what clothes to choose, for example. Where people had short term memory loss staff were patient in repeating choices each time and explaining what was going on.

There were regular reviews of people's health, and staff responded promptly to changes in need. For example, care records showed many examples of staff identifying changes in need and appropriate and timely referrals to health professionals. The registered manager said they often had a waiting list for admissions and the social workers asked them to call when there was a vacancy. An agency care worker said, “This is one of the better homes, you can tell when you walk in. It’s friendly and you get a good handover about everyone so you know what’s going on.” A visiting district nurse said, “I haven’t had any problems, they listen to advice and look after people.” They had advised a test for one person but the staff clearly knew the person very well and had already considered a range of options based on their knowledge of the person’s mental health and previous history. Staff were proud to tell us how one person’s skin had improved with regular position changes, which they were happy to see.

People were assisted to attend appointments with appropriate health and social care professionals to ensure they received treatment and support for their specific needs. For example, staff escorted people to hospital and the communication diary ensured staff were organised so people were ready to go without rushing. One person had had their hair done so they would look their best got a family group photo and not feel anxious about going out. There were no pressure sores associated with skin pressure damage from immobility within the home.

People’s independence was promoted and respected. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. One person was determined to move their wheelchair themselves. Staff waited patiently until the person asked them for help. They told us, “It’s great, they do so well for their age. I hope we will be like them.” Another person was being assisted to book a taxi so they could go and visit a friend. Staff understood how people’s dementia affected their understanding as individuals. For example, one person thought they were still working. Staff chatted with them about taking some annual leave and what the person would like to do with their time off. The registered manager said, “We live in their world. It’s their home so we go with what makes them happy.”

Medicines were well managed and stored in line with national guidance. Records were completed with no gaps and there were regular audits of medication records and administration and to ensure the correct medication stock levels were in place.

Staff were well trained and there were good opportunities for on-going training and obtaining additional qualifications. The staff team was very stable and many care staff had worked at the home for some years. Staff clearly had good knowledge in identifying people's changing needs and providing appropriate care.

Staff were caring and said they enjoyed the homely feel and all spoke of people and their families respectfully. People and staff were clearly enjoying each other’s company and cared about each other. People were all involved with staff decorating the home and preparing for Christmas. People and staff enjoyed friendly banter and showed they knew each other well. People could choose to take part in activities if they wished and when some people preferred to stay in their rooms, staff checked them regularly spending one to one time with them. For example, staff made sure one person was always comfortable and had their soft toy to hand. In particular the chef was very involved outside of the kitchen, enjoying chats with people and including people in their charity events. They had ridden in on their bike with a huge teddy bear for Christmas which people were chatting about. The registered manager and staff also had good relationships with families. They worried about whether a spouse living at home alone was eating, for example. One relative said, “It’s very nice here, we always get a cup of tea.” They spent the morning chatting at the dining tables in the bay window and said, “It’s like being in a nice café.” People were able to see their visitors in communal areas or in private.

The registered manager showed great enthusiasm and passion in wanting to provide the best level of care possible and valued their staff team. For example, organising staff days out, supporting staff with personal issues, involving people in their own lives and working together to ensure people's needs were met as

Dove Tree House is registered to provide accommodation for 34 people who require personal care. The home is situated in Exeter, Devon. At the time of the inspection there were 33 people living there, 17 of whom were living with dementia.

The last inspection of the home was carried out on 21 July 2014. No concerns were identified with the care being provided to people at that inspection.

There is a registered manager in post. 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. Everybody was very complimentary about the registered manager. Staff told us, “I can go to [manager’s name] with anything. I have confidence in them.”

People’s human rights were not being fully protected under the Mental Capacity Act 2005 (MCA) because staff were unclear how the legislation applied to their practice. In addition, people had been assessed as, ‘not having the capacity to make decisions’, rather being assessed in relation to a specific decision at a particular time, as required by the Act. This had not been identified when the care plans were being audited. The provider and registered manager undertook to call an immediate staff meeting to discuss the issue, and arrange additional face to face training to improve staff knowledge and ensure people’s human rights were protected. The effectiveness of the audit system would be discussed at the next managers meeting.

The registered manager was committed to ensuring staff addressed people respectfully. During the inspection we heard some staff addressing people inappropriately. The registered manager assured us they would raise this issue again with them as a matter of urgency.

People and their relatives were unclear whether they had been involved in the drawing up of their care plan, although they had been involved in decisions about their care. The registered manager responded to this feedback by making plans for staff to read and discuss the care plans with people and their relatives and invite people to sign them to record their agreement.

The registered manager told us their ethos was to,” provide a safe, homely environment for people, and consistency and continuity for the residents. That’s what they need to feel safe”. We found they had been successful in achieving this. People told us they felt safe. There were sufficient numbers of staff deployed to meet their needs. They were protected from the risk of abuse through the provision of policies, procedures and staff training, and an effective recruitment process.

Systems were in place to ensure people received their medicines safely. Risk assessments and care plans were effective in enabling staff to minimise risks and support people according to their needs and preferences.

The registered manager was proactive in ensuring people’s healthcare needs were met. This was confirmed by relatives and health and social care professionals.

People had sufficient to eat and drink and received a balanced diet. Special dietary needs were well catered for. Relatives and people were extremely positive about the quality of food and choices available. One person told us, “I enjoy the meal every time”.

People were valued members of the community at Dove Tree House. This sense of community was fostered by the registered manager and staff. One person told us, “I love it here. Especially the staff, they’re brilliant! We all have a good laugh, especially at dinner times”. People were able to take part in daily activities according to their interests. Some of the activities were provided by people living in the home, including a regular quiz and contributions to the newsletter.

People’s relatives were very positive about the care provided to their family members. They said they were made welcome and encouraged to visit the home as often as they wished. They told us the service was good at keeping them informed and involving them in decisions about their relatives care.

There was a committed staff team at the home which was well supported by managers and directors. An induction and training programme was in place to support them to do their jobs effectively. Ongoing professional development was encouraged for all staff members. One member of staff told us,” I just love my job. The staff and residents are lovely. I’ve been off for a week, and I really missed my job”.

The service had a quality assurance system which aimed to ensure they continued to meet people’s needs effectively. The views of people, relatives, staff and external health and social care professionals were actively and suggestions acted on.

We spoke to nine members of staff, ten people who lived in the home, six visitors, the community matron, the district nurse, six people from other professional bodies who were visiting the home.

Is the service safe?

People were treated with respect and their dignity ensured by the staff. We were told by people they had complete confidence in the staff and felt their safety was well accounted for. Staff had received training in Safeguarding procedures and understood how to safeguard the people they supported.

The systems in place ensured that managers and staff learnt from events such as accidents, incidents, complaints and investigations, thus reducing the risks to people. We saw evidence that following a recent Fire Audit, procedures and staff training had been reviewed, ensuring people were protected in the event of a fire.

There were policies, procedures and full training in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards, with staff showing good understanding of when and how an application should be submitted, this means people will be safeguarded as required. We saw that staff knew about the Whistle blowing procedure and how to report any cause for concern.

A comprehensive training programme was in place for all staff, including Manual Handling, Dementia Awareness and Safe Handling of Medicines. This ensured the staff had the knowledge to provide safe care for people. All members of care staff either had NVQ 2 or higher, or were enrolled in NVQ training.

Equipment used was well maintained and safe, with staff fully trained in the use. Specialist training providers delivered training where required for individual items, this reduced the risks to people.

The manager ensured there was sufficient staff on duty, with the necessary qualifications and skills required to meet the needs of people. The rota was continually monitored to account for changing needs and staff requirements, with capacity to respond to unexpected circumstances that might occur.

Recruitment practice was safe, with policies and procedures in place, thus ensuring people were protected from unsafe practice.

Is the service effective?

People were involved in assessing their health and care needs and in the writing of their care plans. Their specific needs were identified in the care plan and information gathered from other professionals and relatives to ensure their care needs were met and the individual was at the centre of the care provision.

Other professionals visited on a daily and as required basis, this ensured a comprehensive service was given to people. We were told that staff were 'continually monitoring a person's changing needs and requested visits from the community team when required'

Dietary needs were assessed and special diets catered for in an imaginative way, ensuring that everyone could enjoy a satisfying and pleasant meal time. Staff received training in all aspects of dietary and nutritional needs

Families and friends were welcome to visit at any time.

Is the service caring?

People told us they were extremely happy with the care they received, that they 'could not speak highly enough of the care given' The atmosphere was relaxed and cheerful, staff were seen to answer call bells quickly.

People told us they could talk to staff about 'anything at all' and were always listened to.

A visitor told us they had been 'very impressed' with the care given. Staff showed a good understanding people's needs and responded in an appropriate manner.

Is the service responsive?

The service was part of the local community, well positioned within the town and involved the community in their activities.

We saw that good use was made of the garden area, ensuring people had ready access to the outside in a safe environment.

We saw evidence of how the service responded quickly to a person's changing needs, how they facilitated changes and ensured any recommendations were carried out. They had close links with other professional services and good referral and assessment system in place.

We saw that monthly newsletters were produced and circulated to all people and their relatives. Three monthly meetings were in place with all invited. Annual questionnaires and feedback forms were important in remaining responsive to people's well-being. There was a complaints procedure in place, but we were told 'I have no complaints but if I had I would just tell the manager, her door is always open.'

Is the service well-led?

The service is well run, with good support from the parent company. We were told that anything needed, such as new equipment would be supplied quickly. Staff told us they felt confident that any problems they had could be shared with the person in charge.

People using the service and their relatives told us the management were approachable and felt the service was well run.

We saw the depth of knowledge and experience within the staff was very high, giving everyone confidence in being able to provide quality care.

We saw evidence of how various quality assurance systems were in place and used to ensure a good quality of service.

We saw how management worked well with other agencies and professionals, ensuring people received the care they needed.

There were 28 people living in the home at the time of our inspection. People were able to move freely about the home where able and were comfortable in the company of the staff who supported them. We saw they responded positively to people who came into the home either to visit or provide entertainment.

The people we spoke with and their visitors were complimentary about the home and told us about how they were involved in deciding about their care treatment and support. We saw how people's care and welfare was provided with dignity and respect in line with their care plan.

The home was clean and tidy and we saw how the manager worked with other professionals to ensure people received appropriate support and that their safety and welfare was protected.

Staffing levels, skills and experience were appropriate to meet the needs of people living in the home.

The provider had improved the way they routinely checked and monitored the services they provided and used the information from those checks to improve their services.

Before people received any care or treatment they were asked for their consent, the provider acted in accordance with their wishes. The people we spoke with said they felt they were consulted about their care and support at all times by staff.

People told us they experienced care, treatment and support that met their needs and protected their rights. One person said 'Staff always know when I'm having a bad day and offer me more help'.

We saw that people were protected from the risks of inadequate nutrition and dehydration through a varied menu, choices of snacks and meals. We saw care plans which reflected dietary needs such as a diabetic diet or food needing to be cut into smaller pieces to help swallowing problems.

People were protected from unsafe or unsuitable equipment through appropriate maintenance and use of the equipment available.

We saw that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard through relevant training and supervision.

We found that the provider did not always have effective systems to regularly assess and monitor the quality of service that people receive.