17 December 2019
During a routine inspection
Tree Top View is a residential care home providing personal care to five people at the time of the inspection. The service can support up to six people between the ages of 18-65 with learning disabilities and autism. There are six ensuite bedrooms with shared communal space. There is a separate building adjacent to the main house that contains a small gym, an education room, laundry facilities and staff offices.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
People’s experience of using this service and what we found
People received an exceptional standard of person-centred care and support which enabled them to experience positive outcomes. This was because the service applied the principles and values of Registering the Right Support and other best practice guidance including Positive Behaviour Support (PBS). PBS is an approach used to understand the behaviour of an individual. It is based on an assessment of the social and physical environment in which the behaviour happens, includes the views of the individual and everyone involved, and uses this understanding to develop support that improves the quality of live for the person and others who are involved with them. These principles ensured that people who used the service could live as full a life as possible and achieve the best possible outcomes that include control, choice, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.
We received extremely positive feedback about the service people received, comments centred around how well the service was led, social inclusion and person-centred care. Relatives told us, “Tree Top View supports each [person] on an individual basis, and with person centred planning. The managers and experienced dedicated senior support staff build up a programme of activities that suits preferences as well as needs. Loved ones are fully supported by the service and parents are included throughout the personalised journey to discover the needs and likes of each resident, the result of which provides a safe, happy and stimulating environment for residents to live, learn and enjoy life in” and “Staff are kind, caring and have the right attitude.”
Staff truly embraced a holistic approach to supporting people in a person-centred way by undertaking thorough assessments of their needs and taking time to understand their preferences, keeping them at the heart of all assessments. Staff received training by the organisation which was person-centred for their needs as well as of those they supported. Staff told us they were supported and the registered manager went over and above to ensure they were safe and happy at work.
The service was exceptionally managed by a team of skilled and co-ordinated staff. The registered manager invested in staff’s professional growth to ensure in their absence the service continued to sustain outstanding outcomes for people. Stakeholders consistently told us about the positive changes to the culture and staffing since the registered manager took over. The registered manager was innovative around staffing and recruitment and they had undertaken a piece of work around agency staff consistency including agreed terms with agency providers for temporary to permanent employment, this ensured candidates were right for the job.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. The senior management team were asked to participate in a steering group with local commissioners to share best practice around restrictive practices. Professionals told us staff were respected for their knowledge and commitment to PBS.
People had achieved significant and life changing positive outcomes since the last inspection. Staff genuinely cared for people and their relatives. There was a clear inclusive culture. Staff were passionate about making a difference to people’s lives and helping them to achieve their goals and challenge their abilities.
People were protected from abuse and avoidable harm. Staff understood about positive risk taking, reporting risk. People’s medicines were managed in a safe and person-centred way. The environment was clean and refurbishment plans had been approved to improve some areas of the environment.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 16 June 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.