Archived: Cherry Trees Care Home

Cherry Trees Care Home is a nursing and residential care home providing personal and nursing care to 57 people aged 65 and over at the time of the inspection. The service can support up to 89 people.

People’s experience of using this service and what we found

Information received prior to the inspection showed people did not always receive safe care. Although staff were trained on how to identify and report suspected abuse, we saw occasions where seven staff members had failed to escalate concerns, which led to delays in safeguarding action being taken. At this inspection people confirmed they felt safe and raised no concerns about the staff who provided their care. Relatives were also complimentary about the staff. We were satisfied the provider had taken appropriate steps to address shortfalls in respect of safeguarding people before we came to inspect.

The home was clean and generally infection prevention control risks were well-managed. Some areas of the building were beginning to show signs of wear and tear, which the management team assured us they had plans in place to address. Medicines were managed in a safe and proper way. Staff were recruited safely and there were enough staff to meet people’s needs.

The culture of the service was not always person-centred as poor practice was not consistently challenged or escalated by other staff members. Staff said the registered manager was approachable and responsive. We felt staff engagement practices could be refined, so staff had more planned opportunities to give feedback about the service or raise concerns should they need to. Where we identified improvements at inspection, the registered manager had taken swift action to address our concerns. The provider had systems in place to monitor and improve the quality and safety of the service. Policies and procedures were straight forward and covered all aspects of service delivery.

Throughout the inspection we saw caring interactions between staff and people who used the service. Feedback received about staff was positive, however, there had been occurrences of poor practice which did not promote people’s privacy and dignity. Although the provider had acted to prevent further occurrences of poor practice before we came to inspect, in order to achieve a rating of ‘good’ overall, more time was needed to show these improvements were embedded into the care people received.

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 23 May 2018).

Why we inspected

We received concerns about poor privacy and dignity practices. As a result, we undertook a focused inspection to review the key questions of safe, caring and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe, caring and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cherry Trees Care Home on our website at www.cqc.org.uk.

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.

Cherry Trees is registered to provide accommodation for up to 89 older people. Accommodation is provided over three floors, accessed by a passenger lift. Communal lounges and dining areas are provided. On the day of the inspection there were 76 people living in the home.

Our last inspection at Cherry Trees took place in 16 October 2016. At that inspection, we found five breaches in the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in Regulation 9; Person centred care, Regulation 17; Good governance, Regulation 18; Staffing, Regulation 11; Need for consent and Regulation 14; Meeting nutritional and Hydration needs. Following the last inspection the registered provider sent us an action plan detailing how they were going to make improvements.

At this inspection, we checked improvements the registered provider had made. We found sufficient improvements had been made to meet the requirements of these Regulations.

This inspection took place on 3 April 2018 and was unannounced. The meant the people who lived at the home and the staff did not know we would be visiting.

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.

Staff were knowledgeable about people living at the home and understood how to meet their diverse needs.

We observed warmth and affection between staff and people who used the service. We saw people were treated with dignity and respect.

People told us they felt safe at Cherry Trees and staff told us they would report any concerns to the registered manager. Systems and processes were in place to ensure that people were protected from abuse and improper treatment.

We found the home was clean and odour free. Bedrooms had been personalised and communal areas were comfortably furnished. The home was well maintained and equipment had been serviced to make sure it was safe to use. However some areas of the service were not adapted to meet the needs of people living with dementia.

We have made a recommendation that the service considers current best practice guidance on dementia friendly environments.

Staff recruitment procedures were robust and ensured people’s safety was promoted.

Sufficient numbers of staff were provided to meet people’s needs.

Staff were provided with relevant training, supervision and appraisal so they had the skills they needed to undertake their role.

Wherever possible, people were involved in decisions about their care and were offered choices. People told us they, and their relatives, had been involved in their plan of care and had participated in regular reviews.

We found systems were in place to make sure people received their medicines safely so their health was looked after.

People were supported to take part in a variety of activities.

People had access to a range of health care professionals to help maintain their health. A varied diet was provided, which took into account dietary needs and preferences so people’s health was promoted and choices could be 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 in the service support this practice. However, we found improvements could be made to in the recording of peoples consent in care records

We have made a recommendation about staff training on Mental Capacity Act 2005 and the Deprivation on Liberty safeguards because the registered provider needed to ensure that any best interest decisions were clearly documented, involved all the relevant people and clearly detailed the outcome of discussions.

Visitors said they were made to feel welcome at any time and were very positive about the care their relatives received.

There was a positive and open culture within the service. Staff said they felt able to raise concerns, and were confident they would be responded to. People and staff were happy with the service and praised the manager.

There was a complaints procedure in place and we saw where concerns had been raised these had been dealt with appropriately.

We saw there were systems in place to monitor the quality of the service. When areas for improvement were identified, action was taken to address these shortfalls.

People using the service were asked for their views and were able to influence the way the service was managed.

Accidents and incidents were investigated, recorded and monitored and action was taken to help control risk and prevent further accidents and incidents from happening.

The registered provider has made progress since our last inspection to improve the service for people living at Cherry Trees Care Home. These changes are very recent and need to be sustained.

There was a manager at the service who at the time of our inspection. 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.

On the first day of the inspection we found care plans were not in good order and confusing. Care plans we saw were in different formats, on a range of different paperwork and were incomplete or out of date.

On the day of our inspection people who used the service were supported by sufficient numbers of staff to meet their care needs.

When we looked at supervision and appraisal records we saw these had been carried out.

We found there some concerns about the availability of specialist food, for example on the day of the inspection people who were on a gluten free diet did not have gluten free bread available.

People had access to a range of healthcare professionals, including GPs, district nurses, opticians and chiropodists. We did find however that people who were living with some conditions were not being adequately monitored to ensure their conditions were stable.

We found some systems were in place to monitor the quality of service provision. However these were not effective and did not always identify concerns. When concerns had been identified there was little evidence to show what actions had been taken to address them. The program of audits carried out by the home manager were ineffective and not carried out regularly.

The home had a complaints procedure and people we spoke with knew how to raise concerns if they needed to. We saw the manager had taken appropriate action when complaints had been received and had resolved them in a timely and effective manner

Staff we spoke with were knowledgeable about safeguarding people from abuse. They told us they would report any concerns straight away.

The provider had system's in place to make sure people were recruited in a safe way. The provider was currently working through staff files to ensure all the correct documentation was present.

During the inspection we found six breaches of the health and social care act. You can see what action we told the provider to take at the back of the full version of the report