Dove Tree House

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 well as facilitating fun opportunities for people. Staff had clearly adopted the same ethos and enthusiasm and this showed in the way they cared for people in individualised ways. People were provided with good opportunities for activities and engagement. These were well thought out in an individual way and people said there was plenty to see and do. During the inspection people and staff were chatting about the lovely Christmas log decorations made by the night staff team. People played a big ball game as advertised on the activity programme and spent lots of time with staff just talking. There was no activity co-ordinator but all staff were involved in providing engagement. For example, the chef was holding a Christmas cake decorating session and various staff ran the home's shop and organised quizzes and games. The registered manager ensured people were part of the community by involving the university students, who ran arts and craft sessions and external entertainers visited. There had been few outdoor trips this year, the provider mini bus was shared between all homes. People mentioned their disappointment at not being able to get out, other than in the lovely large garden. The registered manager was putting this as a priority for the New Year.

Observations of meal times showed these to be a very positive experience, with people being supported to eat a meal of their choice, where they chose to eat it in a homely, attractive environment. Staff engaged in

conversation with people and encouraged them throughout the meal, noting who liked to sit with whom. Nutritional assessments were in place and special dietary needs were catered for as well as specialist crockery and cutlery and finger foods to aid independence for people living with dementia.

There were effective quality assurance processes in place to monitor care and plan on-going improvements overseen by regular provider audits including a 'mystery visitor'. The provider mystery visitor visited the service pretending to be a relative looking for a home for their loved one and staff were assessed on their response from the first telephone to a tour of the home and follow up.

There were systems in place to share information and seek people's views about the running of the home, including relatives and stakeholders. All responses were positive from the recent quality assurance questionnaire such as, "I wouldn't put mum anywhere else" and "Very happy at all times." People's views were acted upon where possible and practical, and included those living with dementia. Their views were valued and they were able to have meaningful input into the running of the home, such as activities they would like to do, which mattered to them.

A monthly newsletter and notice board kept people up to date and organised events such as the Halloween party and fetes encouraged families and children to attend. This showed that people and their families mattered to the staff, who also shared their lives, families and pets.

Further information is in the detailed findings below

The five questions we ask about services and what we found