This inspection took place on 24 January 2019 and was unannounced.

Notrees is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Notrees accommodates up to 16 older people in one adapted building. There were 15 people at the service at the time of inspection, some of whom were living with dementia.

At our last inspection, we rated the service 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.

The registered manager had systems in place to monitor the quality and safety of the home. This included audits, improvement plans and gaining feedback from people and staff. These measures were effective in promoting improvements within the service.

There were enough suitably qualified staff in place to meet people’s needs. The provider had robust procedures in place to monitor recruitment, training, induction and ongoing support of staff. This helped to ensure staff were effective in their role.

Staff were knowledgeable about people’s needs and were caring in their approach. People were treated with dignity and the care they received reflected their preferences. When people received care at the end of their lives, they were given compassionate support which reflected their needs and preferences.

People’s care plans reflected how they would like to receive care. The registered manager had developed these plans using information from people, relatives and healthcare professionals.

Staff understood the need to gain appropriate consent to care. 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.

There were a range of activities which people could take part in and people were able to give feedback to the registered manager to suggest new things to do. The provider had established links with the local community which helped people feel connected to their local area.

Risks associated with people’s health and wellbeing were assessed and mitigated. The registered manager analysed incidents and accidents to establish how the risk of reoccurrence could be reduced.

Risks associated with the environment were well managed to reduce risk of harm. There were plans in place to protect people from harm in the event of an emergency.

The provider had safeguarding policies and procedures in place which helped to reduce the risk of harm to people. Where safeguarding concerns were raised, the provider worked in partnership with local safeguarding teams to help keep people safe.

People were supported appropriately with their nutrition and healthcare. Where risks were identified, the appropriate professionals were consulted and their recommendations were incorporated into people’s care.

The home was a clean, hygienic environment, which was suitable for people’s needs. People had access to outside space and were encouraged to use the garden when possible.

There were safe systems in place to manage people’s medicines.

There were systems in place to respond appropriately when people had complaints or concerns.

Notrees is a small home which accommodates up to 18 people with needs relating to old age. The service does not provide nursing care.

At the time of this inspection the service had a registered manager. 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 service provided safe and effective care. Health and safety issues were managed well and plans were in place to respond to foreseeable emergencies.

People felt they were listened to and they had been involved in their care as much as possible.

People’s legal rights and freedom were protected by the staff. Staff looked after people’s dignity and privacy in the course of providing their care.

People’s physical health and dietary wellbeing were supported. Suitable activities were offered and people’s spiritual needs were provided for. People could choose to what extent they were involved in group or individual activities.

Care plans were individualised and regularly reviewed. They contained the information needed for staff to meet people’s needs.

The service had a robust recruitment process to help make sure that the staff recruited had the necessary skills to meet people’s needs. Staff received training, ongoing support and supervision although not all training was up to date.

The service was well led, and the registered manager provided clear expectations about standards of care. Appropriate systems were in place to monitor the operation of the service and to seek and respond to the views of people and their relatives.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask. We spoke with three of the people living at Notrees as well as a relative and a visiting friend. We also spoke with the registered manager, the home’s acting manager and several of the staff.

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

This is a summary of what we found:

Is the service safe?

People received care and support in accordance with care plans which were regularly reviewed. People and their representatives had been involved in planning their care and the care plans reflected their wishes.

Where people had healthcare needs, the home had sought the advice of external healthcare specialists appropriately to maintain their wellbeing and safety. Staff were aware of the health needs of the individuals they were supporting. Incidents or concerns were monitored and acted upon.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the home had liaised effectively with the local authority DoLS team and had made applications as appropriate. The manager was not aware of a recent Supreme Court judgement relating to ‘deprivation of liberty’ but senior management were and there were plans to review the implications of the judgement for the local authority and then plan an appropriate response across all their services.

The people and relatives we spoke with told us the service was very good and made numerous positive comments about the staff.

Is the service effective?

We saw that the home had a stable and knowledgeable staff team. People’s needs had been effectively met and any changes were referred to management and acted upon. We saw that the people supported enjoyed positive relationships with the staff. The people we spoke with told us the home met people’s needs effectively and provided them with a fulfilling lifestyle. People told us they were allowed to choose how they spent their time.

Is the service caring?

We saw staff working in a caring and respectful way while supporting people. The staff enabled people to make decisions and choices and gave people the time they needed to do things for themselves where possible.

The people and relative we spoke with thought the service was caring. They made lots of positive statement s about the staff including: “the staff are lovely to me.” and: "I get on well with all of the staff.”

Is the service responsive?

We saw that people’s care plans and other documents recorded people’s needs and had been reviewed and updated regularly. Care files showed that the home responded promptly to any changes and sought appropriate specialist advice where necessary.

Care and support was provided based on what people wanted. People had access to a range of meaningful activities, and could also opt to spend time by themselves if that was their preference. Facilities were provided to meet people’s spiritual needs.

The people we spoke with felt that they were involved and consulted and that the service responded to people’s needs. One relative told us: "If I raise it, it is sorted.”

Is the service well-led?

We found that the home provided consistent care to people and was well-managed. There were clear lines of managerial responsibility, although these had been made slightly less straight forward by the recent changes in managerial arrangements. A range of audit and monitoring systems were used by the management team to maintain an effective overview of the home’s operation. Action had been taken to address issues where these were identified. The views of the people supported and their relatives were sought and acted upon.

We spoke with three people who used the service, two relatives, three staff members and the acting manager.

We found that people consented to their care and how it was to be delivered. People told us that they chose the home to live in and said they ‘’couldn’t have made a better choice’’. They were given choices and helped to make as many decisions for themselves as possible. People told us ‘’they always listen to me and I choose as much as I can for myself’’.

We found that people’s health and care needs were well met. People told us ‘’It’s the next best place to your own home’’ and that they felt ’’very safe’’ living there. Relatives told us that they were very happy with the quality of care given.

People told us that the food was ‘’very good’’.

We saw that the home was well maintained and comfortable. People told us that the home was always kept ‘’clean and comfortable’’.

People told us that staff were ‘’ lovely and they always know what they’re doing’’.

The home kept accurate records and stored them appropriately.

People told us that they were always treated with respect and dignity. They told us that they were well looked after. They described the home as a ‘lovely’ place and said it had no faults. People told us that they felt very safe and had never been shouted at or spoken to unkindly. People described staff as very patient and kind to everyone. One person told us that one of the best things about the staff was their cheerfulness and sense of humour. People told us that they were always listened to and issues were resolved quickly.

A relative of someone who lived in the home told us that they were very happy with the quality of care offered and that the home was the ‘perfect’ place for their family member to live.