Archived: Cherry Tree

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At the last inspection in March 2017 the service was rated Good. At this inspection we found the service remained Good.

The service did not have a registered manager in post, however, it was managed by an acting manager who had applied to register with the CQC. 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.

Medicines were not managed safely. We found people's medicines were not always kept securely in locked medicine boxes. This put people's health and safety at risk.

Staff had been trained in the Mental Capacity Act 2005 (MCA) and people's care plans showed mental capacity assessments had been completed and applications for Deprivation of Liberty Safeguards (DoLS) were made to local authorities. We found some staff were not confident in their understanding of MCA.

Although the premises was free from malodours, we noted that there were areas that needed cleaning, repair or replacing. We made a recommendation in this area.

There was a robust staff recruitment system in place to ensure staff were checked and safe to support people.

Staff were provided with induction, training and supervision opportunities. However, their satisfaction with their support from management was mixed with some saying they felt supported and others stating they did not feel well supported.

The service had enough staff to provide care and support for people. However, we noted that the service relied on agency and bank staff to cover shifts due to absence and turnover of staff. The provider was recruiting new staff the reduce the impact of this on the continuity and consistency of care.

Staff had appropriate personal protective equipment and knowledge to ensure the risks of infections were minimised whilst supporting people.

Risks to people were identified, recorded and reviewed. Staff were aware of the steps to take to ensure risks to people were managed.

Various health and safety aspect of the service such as of fire alarms, fire doors, electrical equipment and cleaning were in place to ensure people's safety. One of the fire doors in the annexe was out of order but there was an alternative fire exit whilst this was being rectified.

Each person had a care plan which described their needs, preferences and how they wanted to be supported. People and relatives told us they were involved in the review of their care plans.

People had a choice of meals. Staff supported and encouraged people to choose, prepare and have their meals at the times of their choice. Staff also worked with healthcare professionals to ensure people had access to healthcare.

The service had a complaints procedure presented in a format suitable for people to understand. No complaints had been received since our last inspection. People's communication preferences were identified and staff knew how to communicate with them.

People's preferences of activities were identified and they had opportunities to go to different places of interest.

The provider sought feedback from relatives to ensure that their views were used to improve the service. Regular audits of aspects of the service such as health and safety and the records were undertaken to make sure appropriate action was taken to address any shortfalls.

At the last inspection of this service on 14 January 2016, we found that people who used the service were not protected against the risks associated with unsafe management or administration of medicines. We also found breaches of legal requirements in relation to notifying the Care Quality Commission of important events and having established systems and processes to assess, monitor and improve the quality and safety of the service.

We undertook this inspection to comprehensively look at the whole service again and to check that they were now meeting legal requirements.

Cherry Tree is a service provided by Care Management Group Ltd. It provides care and support for up to seven people with learning disabilities, including some people with complex behavioural and communication needs. At the time of our inspection, there were seven people using the service. There were five people staying in the main building known as Cherry Tree and two people staying in an adjacent building known as the Cherry Tree Annex. The service is located on a property known as Lilliput's Farm in Hornchurch in Essex, along with several other services for adults and children with learning disabilities.

The service did not have 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.

The service was currently being managed by a ‘floating’ manager who had previous experience working for the provider. They had been in post since January 2017. The previous registered manager had left the service after the last inspection and another manager was recruited but they also left a short time afterwards. The provider informed us that the floating manager would register in the interim until a more permanent manager was in place.

We found that the provider was now meeting legal requirements in all areas and we were assured that fundamental standards of quality and safety were being met. The provider had measures in place to ensure the environment was suitable and safe for people using the service. Staff had access to relevant safeguarding guidance and contact numbers. They were aware of their roles and responsibilities to report any potential safeguarding incidents. Risks to people had been assessed and there was guidance in place on how to manage them safely.

People's medicines were managed safely by staff. People received their medicines at the required times and in the way they had been prescribed. Sufficient numbers of staff were trained and authorised to administer medicines.

There were sufficient staff available to meet people's needs. Staff received training in a number of relevant areas to ensure they had the skills to meet people's needs.

People's consent was sought where appropriate. Where people lacked the capacity to consent to decisions, legal requirements were met. People’s records reflected their current health needs. They had access to meet with other healthcare professionals and staff had a good understanding of their needs. People were supported to express their views and to make decisions about their care.

People were supported to eat and drink enough and were given choices when planning the menus. People’s care plans were personalised and contained information about all aspects of their life and histories. Staff interacted well with people and respected their privacy and dignity. People were encouraged to take part in household chores and leisure activities. Their independence was promoted.

There was a complaints procedure in place. Staff were able to support people if they wished to complain. Staff and people told us the management team were supportive, approachable and friendly. There were systems in place to routinely monitor the safety and quality of the service provided.

The management team demonstrated an understanding of their role and responsibilities. They had taken action to address concerns raised by the CQC.

The service did not have a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. When we inspected, a new manager had very recently started in post and was planning to apply for registration to manage Cherry Tree, however by the time this report was published the manager had left and recruitment had commenced.

Our previous inspection on 22 January 2015 found that the service did not meet legal requirements relating to staffing, staff support and development, dignity and respect, safeguarding people from abuse, safe premises and equipment, and safe care. We required the provider to make improvements and took enforcement action to ensure care was provided safely. The provider wrote to us with an action plan detailing how they would improve the service. We conducted a follow-up visit on 18 August 2015 and found that some improvements had been made. During this visit, on 14 January 2016, we found that while some additional improvements had been made, there were still some aspects of the service that needed to be addressed in order to ensure the fundamental standards of quality and safety were met.

People and their relatives told us they were happy with the support they received at Cherry Tree. Staff were knowledgeable about people’s very complex needs and caring in their interactions with them. However, the service had a number of managers in the 12 months before our visit and the lack of consistent, effective leadership was evident in the shortfalls we found.

We found that the service had enough staff to ensure that all people were supported on a one-to-one basis to ensure their safety. However, there were not enough staff with the appropriate training to ensure medicines were always competently and correctly administered, and there was little flexibility in the rota. Some staff were also employed without appropriate levels of experience supporting people with very high support needs and complex, challenging behaviours which left people at risk.

Staff supported people to undertake activities of their choice, however people did not have keyworkers to coordinate their support within the service. This was rectified shortly after our visit.

Staff supported people to eat a nutritious diet and maintain good health. Staff encouraged and supported people to learn new skills and maintain the skills they had.

The service premises were generally clean and staff were aware of their responsibilities. However, one of the bathrooms was damp, mouldy and not safe for people to use when we visited. This was rectified very shortly after our visit. Principles of food hygiene were not always followed by staff.

There was little oversight of the service due to the high turnover of managers. The quality of the service was not checked regularly and action was not always taken to mitigate risks. The provider did not notify CQC of incidents affecting people who use the service as required.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and one of the Care Quality Commission (Registration) Regulations 2009. You can see what action we have told the provider to take at the back of the full version of this report.