Archived: Treehaven Rants

Treehaven Rants is a residential care home providing personal care and support to up to seven people with learning disabilities and or autistic people. At the time of our inspection there were six people using the service. The service consisted of one main house, divided into two areas referred to as "Rants" and "Boomer". Some people had ensuite bathroom facilities, and their own living spaces, other people shared communal areas of the service.

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

The dynamics of the service had greatly changed since our last inspection, with an overall reduction in the number of people living at the service. This had resulted in a positive impact for the standards of care being provided, with people receiving more meaningful care and activities. There was a different registered manager in post, and staff morale had improved. Staff told us they felt more supported and able to meet the demands of their roles.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right support: The standards of care provided, gave people choice and control over their own care and lifestyles. This was supported by consistent levels of staff available to meet people’s assessed needs and risks to enable people to be active members of the local community. People lived in a clean and comfortable care environment. Whilst we identified some areas of improvement needed to the outside of the property, we were assured by the actions being taken by the registered manager in response to our feedback.

Right care: Care records reflected people and their relative’s involvement in their development with their individual wishes and preferences being consistently reflected. People’s dignity, privacy and human rights were being upheld. People were supported to have maximum choice and control of their lives, although a recommendation has been made to ensure key decisions are documented. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff training and competency checks ensured they had the necessary skills, knowledge and expertise to safely meet people’s needs.

Right culture: There was consistent leadership of the service, due to there being an experienced registered manager in place. The registered manager led the service by example, giving the staff clear expectations of the standards they were to uphold. People were empowered to lead meaningful lives and be part of their local community. The continued to be improvements needed in relation to aspects of provider level oversight of the service, and this was reflected in the ongoing breach of regulation identified.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update The last rating for this service was inadequate (published 30 September 2021).

The service had breaches of regulation relating to provision of safe care and treatment, dignified and person-centred support, the condition and maintenance of the care environment, sourcing people’s consent, protecting people from the risk of harm or abuse, the governance and oversight of the service. We took urgent enforcement action as an outcome of the last inspection. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found significant improvements had been made, however the provider remained in breach of the regulations for governance and oversight of the service.

This service has been in Special Measures since 30 September 2021. During this inspection the provider demonstrated improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

The inspection was prompted due to current rating, and breaches of the regulation identified at the last inspection impacting on the safe running of the service, and risks relating to people’s care. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Treehaven Rants on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Treehaven Rants is a residential care home providing support to autistic people and people with a mental health, and or learning disability. The main house is divided into two areas referred to as “Rants” and “Boomer”. The service is registered for up to twelve people, however, because of the adaptations to create more space for people the service chooses to accommodate ten people and eight people lived there at the time of our inspection.

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

Inspectors found the standards of care had significantly reduced since the last inspection.

The support and care people received was based on the availability of staff and routines were staff led and not around the needs and interests of people using the service. People did not have consistent care and regular routines which were identified as very important to them.

The attitudes and behaviours of staff did not ensure people received safe care. There was a culture of underreporting which meant people were not protected from possible abuse. People were exposed to unnecessary risk and were living in an environment which did not promote their wellbeing or keep them safe.

At the last inspection although rated good, concerns were raised about the condition of the environment and external grounds. Despite assurances being provided by the registered manager at the time that these issues were being addressed we found at this inspection widespread neglect of the care environment. The environment was no longer fit for purpose, neither was it hygienically clean. We found multiple issues with the environment which posed some immediate risks and had resulted in one person being temporarily removed from their flat without consultation with family or other health care agencies to ensure it was in their best interest. We sought immediate assurance and clarification of urgent works and went back on site a week later to check remedials works had been completed.

We asked for assurances from the registered manager of the cleanliness of the service as we found no evidence that staff were routinely cleaning the service or that enhanced cleaning schedules had been put in place since COVID-19. The building was visibly dirty throughout. A deep clean was authorised by the provider and took place. When we returned a week later, we noted some improvement but were concerned about the continued lack of regular cleaning of the premises.

During the restrictions imposed on the country as a result of COVID-19 we found that people had not been appropriately supported or adequately protected from contracting the virus.

A high number of incidents of behaviour had occurred which could be attributed to a change in people’s routines and restrictions on their day to day lives. Incidents were not managed well or appropriately escalated. There was poor incident analysis, and adequate steps were not taken to reduce the likelihood and, or severity of incidents reoccurring. Several incidents such as trips and falls could have been avoided if appropriate, timely actions had been taken by staff.

The service was poorly managed, and governance and oversight were weak. A new registered manager had come into post in August 2020. They had not been appropriately supported and had been unable to effect positive change within the service because they told us they were constantly, ‘Firefighting.’ A poor staff culture meant staff were not working together in a cohesive way to make lives for people living at the service better.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

People did not have a voice and were not able to influence the service they received. Staff did not maximise people’s independence or enable people to retain or develop new skills.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The last rating for this service was good (published 22/03/2019).

Why we inspected

The inspection was prompted in part due to concerns received about the service in relation to a number of safeguarding incidents and concerns about other locations under the same care provider.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

During the first day of our inspection we identified serious concerns. We sought immediate assurances from the provider about actions we wished them to take and asked the provider to confirm in writing the actions they had taken. We went back to the service to check they had made some immediate improvements requested. We found the provider had taken some initial remedial actions, but there continued to be significant risks and concerns present at this inspection.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the key questions of safe, effective, caring, responsive and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Treehaven Rants on our website at www.cqc.org.uk.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care which included: infection control, safe care and treatment and the management of medicines. Safeguarding people from harm and risk. staffing levels, staff training and competencies. We also found breaches in relation to consent, dignity and respect as well as with the condition of the care environment. Management and governance, and registration requirements both notifications and adhering to conditions of registration were also areas where we found breaches.

Since the last inspection we recognised that the provider had failed to act within its own registration conditions. This was a breach of regulation. Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is now placed in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

¿ Treehaven Rants provides accommodation with personal care for up to 12 people living with autistic spectrum disorders and/or learning disabilities. The premises consisted of two bungalows that each provides four ground floor bedrooms and a self-contained flat.

People’s experience of using this service:

¿ Areas of the service looked tired and some furnishings and fittings were damaged and in need of redecoration or repair. For example, flooring in the kitchen area had holes in it. There was no dedicated maintenance person, since the last one left and maintenance has been carried out by an external contractor. This meant that small jobs were either not completed or there were long delays in responding to needs.

¿ The registered manager told us that the redecoration and replacement of furnishings was included in the provider’s annual development plan. However, although the annual development plan contained some details about improvement work, it did not contain details of the plans to re-decorate and refurbish the service. Following the inspection we were sent a maintenance list that showed areas that needed to be addressed and we saw that some improvements had been completed.

¿ The registered manager told us they had secured a regular company to provide the maintenance of the service and we saw that some work had commenced. For example, the gardens were being maintained on the day of our visit and improvements had been made to the driveway.

¿ People continued to feel safe living at the service. Risks to people’s health, safety and welfare had been identified and were known by staff. Staffing levels were appropriate to meet the needs of the people using the service. Medicines were safely managed. The service was clean and hygienic, although some areas were difficult to keep clean because they were damaged. There were systems in place to monitor incidents and accidents and learn from these.

¿ People’s care, health and cultural needs were identified so staff could meet these. The staff were skilled and competent and knew the people they supported well. People said they liked the food served and had a choice of different meals. People were supported to maintain good health and referred to health professionals when required. Staff worked within the principles of the Mental Capacity Act (MCA) 2005 and ensured people consented to their care.

¿ People continued to receive care from staff who were kind and caring. People were encouraged to make decisions about how their care was provided and their privacy and dignity were protected and promoted. People had developed positive relationships with staff who had a good understanding of their needs and preferences.

¿ People received person centred care that met their needs. Care plans were person centred and set out how staff should meet their needs. The staff team were knowledgeable about people’s needs. Managers and staff ensured information was provided to people in an accessible format. People took part in a range of group and one-to-one activities depending on their preferences. People said they knew how to make a complaint if needed.

¿ People, relatives and staff told us the service was well managed and had an open and friendly culture. Staff said they felt well supported and the management team were open and approachable. The provider’s audit system covered all aspects of the service and helped to ensure the care people received was appropriate and safe. Managers and staff worked in partnership with other agencies to ensure people got the care and support they needed.

More information is in Detailed Findings below:

Rating at last inspection: Good (report published 15 June 2016)

Why we inspected:

This was a planned inspection based on the rating at the last inspection. At our last inspection we rated the service Good. At this inspection we found the effective domain had changed to requires improvement. The overall rating for this service remains Good.

Follow up:

We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

People were safe and lived in a safe environment because there were enough well trained staff to support people and appropriate recruitment checks were carried out before staff began working in the home. Identified risks to people’s safety and wellbeing were recorded on an individual basis. There was clear and detailed guidance for staff to be able to know how to support people safely and effectively.

Medicines were managed, stored and administered safely in the home and people received their medicines as prescribed.

People were supported effectively by staff who were skilled and knowledgeable in their work. All new members of staff completed a full induction and staff were supported well by their seniors, the manager and the deputy of administration.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and to report on what we find. These safeguards protect the rights of adults using the services by ensuring that, if there are restrictions on their freedom and liberty, these are assessed by professionals who are trained to assess whether the restriction is needed. Appropriate DoLS applications had been made for all eight people currently living in Treehaven Rants.

People were supported to eat and drink sufficient amounts and, when necessary, people’s intake of food and drinks was monitored and recorded. Prompt action and timely referrals were made to relevant healthcare professionals when any needs or concerns were identified.

Staff in the home were caring and attentive. People were consistently treated with respect and staff preserved people’s dignity. People were encouraged and supported to be as independent as possible and their relatives were welcome to visit them. People were also supported to undertake activities or hobbies of their choice.

Detailed assessments were completed prior to admission, to ensure people’s needs could be met. These assessments were also reviewed and updated on a regular, on-going basis. People were involved as much as possible in planning their care and received care and support that was individual to their needs. Risk assessments detailed what action was required or had been carried out to remove or minimise identified risks.

People were supported to raise concerns or make a complaint if needed. Concerns were listened to, with appropriate responses, and remedial action was taken where possible.

The service was being well run and people’s needs were being met appropriately. The manager and deputy of administration were approachable and open to discussion. Communication between the staff, management and people living in the home was frequent and effective. However, some staff said they would appreciate more direct communication and updates from the provider regarding the service. To try and address this issue, the provider had appointed an employee relations officer at the beginning of 2016. In addition, a staff representative had also been elected for the service.

There were a number of effective systems in place in order to ensure the quality of the service provided was regularly monitored. Regular audits were carried out by the manager and the provider’s compliance manager. These identified areas that needed improvement and appropriate action was taken to do so.

Another person was listening to music in their room, which they expressed they enjoyed very much. A third person was watching films in the lounge and indicated that they particularly liked westerns.

Staff we spoke with showed a good understanding of individuals' specific support requirements. For example, some people living in the home didn't want a female supporting them and we saw that staff worked in accordance with this requirement.

Meetings were held each evening with people living in the home to choose what they wanted for their meals the following day. We saw that photographs of real food were also used, to help people make informed choices.

No errors or omissions were noted from the Medication Administration Records (MAR) we looked at.

The staff records showed that staff completed a full induction upon commencement of their employment and we saw records of training that had been undertaken. Staff confirmed that they received regular support and supervision with their line managers.

We noted that people living in the home were regularly supported to make their views known during meetings and one-to-one time with staff.