Cherry Tree Lodge

Cherry Tree Lodge cares for people who have a learning disability and/or autism. It provides accommodation for up to nine people who require personal care. On the day of our inspection there were nine people living at the home.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to nine people and nine people were using the service. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by individual rotas of core staff. The building fitted into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

There was a strong and empowering approach to managing people’s safety which focused on openness, transparency and learning when things went wrong. The provider embedded technology in service delivery which support staff to provide people with truly person-centred care. There was a strong ethos based around people as individuals and recognising the value of their expertise in how their own care should be delivered. We received overwhelmingly positive feedback about the leadership of the service. The running of the service centred around the experience of people.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensured people who used the service lived as full a life as possible. Support focused on people having as many opportunities as possible to gain new skills and become more independent.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism.

Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of the thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

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 20 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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 Tree Lodge specialises in the care of people who have a learning disability. It provides accommodation for up to nine people who require personal and nursing care. On the day of our inspection there were nine people living at the home.

At the time of our inspection there was 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.

We found that staff interacted well with people and people were cared for safely. The provider had systems and processes in place to safeguard people and staff knew how to keep people safe. Risk assessments were in place and accidents and incidents were monitored and recorded. Medicines were administered and stored safely. Arrangements were not in place to ensure appropriate advice was sought where people required their medicines to be given in food. We have made a recommendation about the providers medicine policy.

The provider acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).If the location is a care home the Care Quality Commission is required by law to monitor the operation of the DoLS, and to report on what we find.

We found that people’s health care needs were assessed, and care planned and delivered to meet those needs. People had access to other healthcare professionals such as a dietician and GP. Staff were kind and sensitive to people when they were providing support. Staff had a good understanding of people’s needs. People were supported to pursue leisure activities and access local facilities.

Staff were aware of people’s need for privacy and dignity and made arrangements to provide this.

People were supported to eat enough to keep them healthy. People had access to drinks and snacks during the day and had choices when planning meals. Where people had special dietary requirements we saw that these were provided for.

There were sufficient staff available to meet people’s needs however staff retention had been problematic. Staff were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs.

Staff felt able to raise concerns and issues with management. A process for raising concerns was in place. People and relatives knew how to complain and the provider recorded and monitored complaints.

Audits were carried out on a regular basis and action put in place to address any concerns and issues.

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 who used the service, their relatives 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.

Is the service safe?

The provider had policies and procedure in place in relation to the Mental Capacity Act MCA (2005) and Deprivation of Liberty Safeguards (DoLS). The MCA states that every adult has the right to make his or her own decisions and must be assumed to have capacity to make them unless it is proved otherwise. The Deprivation of Liberty Safeguards are part of the MCA. They aim to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom.

Carers had received appropriate training in safeguarding people from abuse and the provider worked collaboratively with the local safeguarding team to investigate any concerns raised.

Care plans included sufficient information to enable staff to respond appropriately to challenging behaviour in a way which minimised the use of physical intervention.

Is the service effective?

People's health and care needs had been assessed and care plans were in place. Risks to people's health were identified and action taken to reduce the risks to people and to help them maintain their independence.

Is the service caring?

We saw there was a warm and caring relationship between staff and people who lived at the home. We also saw people were supported to be involved in their care. For example, we saw one person was being supported to book a holiday. They were excited about their holiday and staff talked about what they were going to do while they were away.

People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

We saw the provider had an appropriate complaints policy. We spoke with a family member of a person who lived at the home. They told us they knew how to raise a complaint had done so and were happy with the outcome.

Is the service well-led?

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

The service had a quality assurance system in place, records seen by us showed that identified shortfalls were promptly addressed. As a result the quality of service was continually improving.

We spoke with three people who lived at the home, although in some cases due to their needs we were not able to have long conversations with them. In response to our question, "Do you like living at Cherry Tree Lodge," one person replied, "A big yes." Another person said, "I'm happy; the staff are really nice."

The accommodation was adapted to meet the needs of the people living there and the facilities had been recently extended and improved. We found the home was warm, clean and was personalised to the people who lived there.

We observed that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where people did not have the capacity to consent, we found the provider acted in accordance with legal requirements.

We saw that people's support plans and risk assessments reflected their needs and were up to date. Staff we spoke with were aware of the contents of the support plans, which enabled them to deliver appropriate and safe care.

The provider had systems in place that ensured the safe receipt, storage, administration and recording of medicines. The provider ensured staff were supported and trained to care for people safely.

The relatives we spoke with talked positively about the service provided. Comments included, 'The transition plan was very well planned. Staff received additional training before my daughter moved in, to make sure her needs could be met.' And, 'My son has never been more relaxed and confident. He is learning and developing all the time.'

We found people who used the service were given appropriate information and support regarding their care and support. We saw information such as the service user guide and other supporting information was in easy read language.

We found people received care and support that met their safety and welfare needs. Some people had additional needs and required one to one support, we saw people were receiving the correct level of support as stated in their support plan.

We saw medicines were safely administered by staff that were trained, knowledgeable and competent.