Treehouse Care Domiciliary Care Services is a domiciliary care service based in Grimsby. The service provides personal care and support to people living in their own homes, who have a learning disability and/or autism spectrum disorder. At the time of our inspection two people received care from the service.

We last inspected the service on 31 March 2015 and rated the service as good. At this inspection we found the service remained good and met all the fundamental standards we inspected against.

The service had a registered manager in post. 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.

Recruitment procedures were thorough and there were sufficient staff, used in a flexible way to support people’s needs. Staff knew how to safeguard people from the risk of abuse and harm; they had received training and had procedures to guide them. There were procedures in place to manage risk which helped to ensure people were safe whilst not being too restricted.

People’s health and nutritional needs were met. People were supported to attend appointments and access community health care professionals for advice and treatment when required. Medicines were managed effectively and staff ensured people had their medicines as prescribed. The menus were developed with people where possible and provided them with a variety of nutritious meals.

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. Staff approach was observed as kind, caring and compassionate. They treated people with dignity and respect whilst still maintaining a friendly and professional manner. There were very positive comments from people who used the service, relatives and visiting health and social care professionals about the registered manager and staff team.

Staff supported people to be involved in their care and to make choices about how they spent their time. Wherever possible, staff encouraged people’s independence and supported them to access the local community.

We saw from records that staff had received training appropriate for their development, supervision and appraisal. Staff told us the registered manager was supportive of them. They felt listened to, able to make suggestions and were confident in supporting people who used the service.

There was a quality monitoring system in place which consisted of audits, checks, the management of complaints and obtaining people’s views about the service.

This inspection took place on 31 March 2015. The registered provider received short notice of our intention to inspect the service. This is in line with our current methodology for inspecting domiciliary care agencies.

The service provides care and support to people in their home. On the day of our inspection, one person was receiving care.

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 person who used the service was supported by a small number of consistent staff who were familiar with the person’s individual needs and preferences. The staff were properly trained and well supported to effectively meet the person’s care and support needs. Staff knew the person very well; they had been providing consistent care support for many years, which meant they could identify any changes in the person’s health or support needs.

The person who used the service told us they felt safe. They said, “I feel safe in my new house.” Staff understood the various types of abuse that could occur and knew who to report any concerns to. There were appropriate arrangements in place to ensure people’s medicines were obtained, stored and administered safely.

Staff had developed positive relationships with the person who used the service and treated them with respect and kindness.

The person who used the service was involved in determining the kind of support they needed. Staff offered the person choices, for example, how they spent their time and what they wanted to eat; these choices were respected.

The person who used the service was encouraged to express their views about the way their care was delivered. This included face to face meetings with the registered manager each month, written surveys and through regular telephone contact. They told us they were happy and regularly spoke with the registered manager.

The service worked closely with local specialist support services and agencies to ensure the person received the most effective care and had opportunities to lead a fulfilling life. The person was attending regular classes and sessions at three different community support and educational placements.

Staff responded promptly to changes in the person’s needs to ensure appropriate support was provided. The person’s nutritional and dietary needs had been assessed and they were supported to plan, shop for ingredients and to prepare their own meals.

The service had a clear management structure. Staff felt comfortable about sharing their views and talking to the registered manager if they had any concerns or ideas to improve the service provided. Staff demonstrated a good understanding of their role. Effective systems were in place to monitor the quality of the service.

We observed staff interacting with the person maintaining mutual respect; they were relaxed and confident with the staff. We saw that the person was supported to make choices and decisions.

Staff told us that when the person who used the service needed other health care professional’s intervention, care officers would make a direct entry into the persons care plan and arrange visits. Records we looked at corroborated this.

We looked at three staff files in respect of their job application and initial recruitment. Records we looked at confirmed that they had attended an interview, completed a written test, had provided two references and did not commence work until a Disclosure and Barring Services (DBS) check had been completed.

We looked at records of monthly team meetings during which discussions included health and safety, safeguarding, local authority and staffing. Records confirmed meetings were well attended and staff had the opportunity to input to the effective running of the service.

The manager told us, “All our policies and procedures are maintained electronically in the service and on paper at the person’s home. We also have a system that backs-up electronic information on a daily basis and the tapes are stored separately in a locked safe.” This ensured the service had a system to restore information in the event of a disaster.

Where people did not have the capacity to give consent, the provider acted in accordance with legal requirements. Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

People expressed their views and were involved in making decisions about their care and treatment. An ‘assessment pathway plan’ was undertaken of a persons needs before they made the transition from the children’s service to an independent living situation. This information was used to develop a care file.

Staff spoken with described the different types of abuse and demonstrated a sound understanding of the potential for abuse. They knew what to do if abuse was suspected or alleged. The provider responded appropriately to any allegation of abuse. We were told “I have used the whistle blowing policy more then once” and “I’m happy to report things to my manager.”

There were enough qualified, skilled and experienced staff to meet people’s needs. Bespoke packages of support were designed and paid for by Hull County Council, people using the service received 24 hour one to one support.

The complaints policy we saw stated that any complaint would be acknowledged within 24 hours and the manager would respond formally with 28 days. The policy included information about how to contact the managing director if the complainant was dissatisfied with the outcome of the investigation.

People we spoke with were very positive about the care and support they received. They told us they were well cared for and were encouraged to be as independent as possible. One person told us about their job and another person told us how staff supported them to manage their cleaning and laundry.

We asked people to describe how they spent their time and what they enjoyed doing. One person told us they enjoyed walking their dog the best, and how they liked to go to a local youth club. Another person told us about their college and how they liked to have take away meals and sometimes go out for dinner.

When we spoke with people they told us they felt safe and they trusted the staff. Some of the comments we received included, "Yes, I feel safe”,” The staff are nice” and “If I had any problems I would speak to the manager."