Dove Tree House

Updated 9 January 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 3 December 2018. This was an unannounced inspection and was carried out by one adult social care inspector.

Before the inspection we reviewed the information we held about the service. This included notifications the provider is required by law to send us about events that happen within the service. The registered provider had completed a Provider Information Return (PIR). The PIR is a form that asks the registered provider to give some key information about the service, what the service does well and improvements they plan to make. At our last inspection of the service in 2016 we did not identify any concerns with the care provided to people.

During the inspection we spoke with eight people who lived at the care home, a visiting health professional and two visiting relatives. We also talked with various people who worked at the care home including the registered manager, deputy manager, five care workers, an agency care worker, the chef, a domestic and the maintenance man.

As some people were living with dementia, we also observed the way staff interacted with people living in the home and performed their duties. We looked at three care records, three staff files and a range of other documents that related to the overall management of the service which included training records, quality assurance audits, medicine administration sheets, complaints records, and accident and incident reports.

Updated 9 January 2019

At our last inspection we rated the service good with requires improvement in the question of effective. This was because at the time of the last inspection in August 2016, staff were unclear about the best interest decision making process to ensure people’s rights were protected. During this inspection in December 2018, this had been addressed and the question of effective was rated as good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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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