Archived: Cherry Tree House

Cherry Tree House is a residential care home providing care for up to 20 older people. Until April 2016 the home had a registered manager in place. At the time of the inspection a new manager had been appointed and had applied to be registered with the Care Quality Commission. The previous registered manager had changed roles in the home, and was therefore still employed but in a different capacity.

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 new manager had been in post for five weeks at the time of the inspection. They were in the process of receiving a handover and induction from the previous manager and being supported by the provider.

We looked at care plans and risk assessments and found them to be up to date and reviewed regularly. We found records for a person receiving respite care were not as comprehensive as those for people who lived permanently in the home. This was rectified by the manager.

Checks carried out prior to the employment of staff were not always robust. We found newly employed staff were shadowing more experienced staff before their references and Disclosure and Barring Service (DBS) checks had been received. Gaps in employment histories and reasons for leaving previous employment had not been investigated or documented.

We found medicines were being stored and administered in a safe way. Audits were completed to ensure practice was safe.

We observed sufficient numbers of staff to meet people’s needs. However, comments and feedback forms mentioned the need for more staff. The manager told us this was in relation to periods of time when staff were busy due to increased demand. They were looking into how they could support staff during these busy periods.

Staff knew how to identify and report concerns of abuse. The manager was clear about the process for reporting concerns and how to protect people.

People and their relatives told us staff were skilled in how to care for people and encourage independence.

Information related to staff training was incomplete. For example the training matrix showed only one staff member had completed training the provider deemed as mandatory. The training policy was out of date. When speaking to staff we found they did not understand the Mental Capacity Act 2005 (MCA) or Deprivation of Liberty Safeguards (DoLS) and how these applied to their role. This was important in order to protect people’s rights. This was an area the manager planned to make immediate improvements in. Staff received regular supervision and felt able to approach the manager and their colleagues for support and guidance.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The manager had taken appropriate action to apply for a Deprivation of Liberty Safeguards (DoLS) for one person.

Staff demonstrated limited understanding of the Act and DoLS. We have made a recommendation about MCA and DoLS training for staff and associated records.

People received good support with eating and drinking by staff who knew their needs well.

Food was well presented, nutritional and tasty. The chef clearly had a good relationship with the people in the home, who told us the chef met their needs and preferences.

Overwhelmingly people and their relatives told us how caring and kind the staff were to them. We observed this during our visit. There was a gentle and fun approach displayed by carers. We got the impression staff knew people well and were able to communicate with them in a way that showed respect to people.

Where possible people or their relatives were involved in the planning of the care they received. Consent was obtained from people and their opinions and preferences were recorded. People spoke positively about the home and the sense that it was “a home from home.”

Activities were available to people to ensure they did not experience social isolation.

People and staff spoke positively about the new manager and the managerial staff in the home. We were told they were supportive and managed the service well. From our discussions with the manager we noted they had already identified areas that could be improved and had developed a good rapport with some of the staff.

Checks were in place to ensure the safety of equipment. Audits had been completed to assess the standard of care being provided. Feedback was obtained from people and staff to drive forward improvements to the service.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). The registered manager told us they had not had a need to make an application to deprive anyone of their liberty although they would make an application if the need arose.

People's care and support had been planned and delivered in a way which ensured people's safety and welfare. Risk assessments had been completed with guidelines in place for staff to follow. These enabled staff to manage risk safely and promote people's comfort and safety.

Procedures were in place to deal with foreseeable emergencies. We saw personal evacuation plans(PEP) had generally been documented in people's care files. These provided staff with guidance on how to evacuate the premises in a safe way in an emergency such as an outbreak of fire. However, we did note one person's file did not contain a PEP.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. Audits of the quantities of medicines held within the home were being completed and there was evidence that MAR charts were checked. This ensured systems were in place to monitor the amount of medication in the home and check people had been administered their medication as prescribed by their GP..

From our observations during our visits it appeared to us there were sufficient staff to meet the needs of the people who used the service.

These findings demonstrated to us the service was safe.

Is the service caring?

People's care plans were individualised and centred on each person's specific needs. We saw evidence that people and their family members were involved in the planning of the care and support. This enabled them to be have a say in how they wished their care and support to be provided taking into account their wishes and preferences.

Throughout the visits we observed staff interacting with people living in the home. Staff were seen to be talking and supporting people in a kind, gentle and attentive way. Staff showed patience and encouragement when supporting people and had a good understanding of people's needs and knew them well. People described staff as ''good, very kind and marvellous.'' One person added ''They look after us well and make our visitors welcome.''

The findings throughout our inspection showed the staff were caring.

Is the service responsive?

The service was responsive to people's individual needs in relation to their health, social and personal care needs. Records had been maintained of appointments with health care professionals and any advice given was recorded and care plans were generally updated to ensure their needs were met appropriately.

People were consulted with in relation to the choice of activities provided. This ensured their individual social needs were catered for according to their preferences and interests.

Any accidents and incidents were recorded and investigated appropriately.

Is the service effective?

A pre-admission assessment of people's needs had been undertaken before they moved into the home. The manager visited people in their own homes, or in hospital before they were admitted. This enabled the manager to discuss people's needs with them and/or their family and next of kin. This enabled all parties to discuss the services provided and whether they felt it suited their needs.

Support for staff was provided through training, and supervision. 'Spot' checks were undertaken to monitor staff practices to ensure they were competent and provided care appropriately and according to the organisation's procedures.

People received co-ordinated care. We saw evidence in people's care plans which demonstrated people had been visited by their GP and other health care professionals and appropriate advice sought when required.

Any accidents or incidents were recorded appropriately detailing the actions taken and risk assessments had been updated documenting any further measures put into place to prevent a recurrence.

It was evident through discussions with staff and through observing their interactions with people that they had a good relationship and understanding of everyone's needs and knew them well.

These findings demonstrated to us that the service was effective.

Is the service well led?

The provider was very much involved in the day to day care provided, by talking to people and their relatives, speaking with staff and observing their practices. This meant any issues raised or observed could be dealt with immediately.

People's views were actively sought through reviews of their care and support, quality questionnaires and on a general day to day basis. This enabled people to review the quality of the services provided and make suggestions where improvements could be made.

Regular meetings were held for people who used the service. These provided people with the opportunity to raise any concerns, gain feedback on particular aspects of the services provided such as the variety of activities and choice of meals.

Staff felt the manager was very supportive and told us they found them approachable. Staff also told us they felt valued and worked well as a team.

These findings demonstrated to us that the service was well led.

People had access to healthcare professionals and specialist support to ensure they kept healthy and well.

Activities were provided for those who wished to take part. They included one to one activities and group sessions. They were tailored to people's likes and dislikes to ensure their social care needs were met appropriately.

People told us that they liked the staff and felt they met their needs well. They said that they were able to choose how they spend their day, including the time they chose to get up and retire to bed.

We found people were treated with dignity and respect. We observed people in the dining room during tea time. We saw staff offered people choice of food and people were not rushed and were able to eat their tea at their own pace.

The home was comfortable, clean and warm and some areas had been recently redecorated. Each person had their own bedroom which they had personalised to their own taste.

Systems were in place to regularly assess and monitor the quality of service that people received to ensure people benefitted from safe quality care and support.

Care plans were in place and documented people's individual needs. People's needs, preferences and their care plan had been discussed, planned and agreed with them. They were individualised and described what the person was able to do themselves and what they required support with. We found them to be detailed, reviewed and updated regularly.

Risk assessments had been written to identify and reduce the likelihood of injury or harm, with guidelines in place for staff.

People had access to healthcare professionals and specialist support to ensure they kept healthy and well. An account of any visits and actions to be taken were documented to ensure staff met people's needs in the most appropriate way.

Daily activities were provided to those who wished to take part. These included trips out into the community as well as in house activities and entertainment.

People told us they were happy with the service and felt their needs were met well. Comments included ''I am very happy, they look after me well.'' ''The staff who look after us are extremely kind.'' A relative told us they were pleased with the care and support their relative received and said the home kept them informed about any changes to their health. The relative said ''I go to work and feel comfortable that he is safe and well looked after.''