Archived: Cherry Lodge

About the service

Cherry Lodge is a residential care home providing personal care to 6 people at the time of the inspection. Cherry Lodge provides care to people with a diagnosed learning disability or mental health need. The service can support up to 9 people, and the home was at full capacity at the time of inspection.

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

Right Support: People were supported by staff to pursue their interests. People had a choice about their living environment and were able to personalise their rooms.

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.

Right Care: Staff did not always understand how to protect people from poor care and abuse. Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care. People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs.

Right Culture: Governance processes were not always effective. The service enabled people and those important to them to work with staff to develop the service. Staff valued and acted upon people’s views. Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing.

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 06 March 2018).

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We have identified a breach in relation to good governance at this inspection. We have also made a recommendation in relation to identifying safeguarding concerns.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The home was cleaned to a high standard throughout. Cleaning schedules had been increased to ensure that specific areas identified as high risk of transmission of the virus, such as light switches and other touch points, were cleaned several times per day.

All staff participated in a weekly testing programme for coronavirus. In addition, staff took a lateral flow test (LFTs) prior to the start of each shift. If any staff member returned a positive test they were not able to work. Staff supported people who lived in the home to undertake regular tests. While the core staff team were isolating, the provider engaged exclusive agency staff who were also required to undertake LFTs prior to starting their shift.

The provider ensured that people were supported to manage their isolation period within their home. The service provided disposable cutlery, crockery and cups to reduce the risk of transmission through these items. The service also provided takeaway meals through the isolation period to reduce risks.

Staff supported people who lived in the home to understand the virus and the additional measures introduced in the home to reduce risks. Most people watched the news and understood the need to isolate, and did so without hesitation. Staff supported people to maintain contact with their loved ones through this period by video and phone calls.

There was enough personal protective equipment for staff to use and we observed staff using it according to government guidance. Staff told us how valuable they found the support they received from the registered manager, the provider, the local authority and the clinical commissioning group through this period.

The provider’s IPC policy was up to date.

The bedrooms are based on three floors and each floor has shared bathroom facilities. There is a lounge and well equipped kitchen on the ground floor and access to a large garden. The home is close to local amenities including shops, cafes, a library, and churches and had good transport links to the local towns and London.

At the last Care Quality Commission (CQC) inspection in March 2016, the overall rating for this service was Good. At that inspection we rated safe as Requires Improvement because window restrictors were not adequate to prevent a person falling from the window. The provider immediately changed the window restrictors and we found these were of a type that would help to prevent an accident.

At this inspection we found the service remained Good and we changed the rating of safe from Requires Improvement to Good. The service demonstrated they continued to meet the regulations and fundamental standards.

People remained safe at the home. Staff could explain to us how to keep people safe from abuse and neglect. People had suitable risk assessments in place. The provider managed risks associated with the premises and equipment well. There were enough staff at the home to meet people’s needs. Recruitment practices remained safe. Medicines continued to be administered safely. The checks we made confirmed that people were receiving their medicines as prescribed by staff qualified to administer medicines.

People continued to be supported by staff who received appropriate training and support. Staff had the skills, experience and a good understanding of how to meet people’s needs. We saw that staff encouraged people to make their own decisions and gave them the encouragement, time and support to do so. Staff were providing support in line with the Mental Capacity Act 2005. People were supported to eat and drink sufficient amounts to meet their needs. People had access to a range of healthcare professionals.

The staff were caring. The atmosphere in the home was calm and friendly. Staff took their time and gave people encouragement whilst supporting them. Throughout the inspection we saw that people had the privacy they needed and were treated with dignity and respect by staff.

People’s needs were assessed before they stayed at the home and support was planned and delivered in response to their needs. People could choose the activities they liked to do. The provider had arrangements in place to respond appropriately to people’s concerns and complaints.

We observed during our visit that management were approachable and responsive to staff and people’s needs. Systems were in place to monitor and improve the quality of the service. Audits of the premises helped ensure the premises and people were kept safe.

The service provides personal care and support for up to nine people with mental health issues within a care home setting. There were eight people using the service 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.

The premises were not always safe because the provider had not assessed and mitigated the risk of falling from height through unsecured windows. However, the provider acted promptly to mitigate this risk when we raised our concerns with them. Other areas concerning health and safety in the home, however, were well managed to keep people safe.

Medicines management was safe. Processes for checking people received their medicines as prescribed were robust. There were sufficient medicines in stock for people and medicines were stored safely. Procedures for receiving and returning medicines to the Pharmacy were in line with best practice.

Staff understood how to recognise abuse and how to report any concerns they had relating to this. The registered manager raised safeguarding allegations with the local authority safeguarding team and took action to keep people safe when allegations of abuse had been made. People had appropriate risk assessments in place with risk management plans to manage the risks and these were reviewed regularly.

The manager followed a robust recruitment process so that only suitable staff worked with people at the service and there were enough staff deployed to meet people's needs.

The manager and most of the staff understood their requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS), and they had been provided training in these areas. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them. The manager had considered whether people required DoLS as part of keeping them safe and none did at the time of our inspection.

People received the necessary support to receive appropriate food and drink and people’s preferences, cultural and religious needs relating to food and drink were met. Staff supported people with their health needs and people had access to the health services they needed.

Staff received the right support to understand and meet people's needs and the responsibilities of their role through a programme of training, support, supervision and appraisal.

Staff were caring and understood people’s needs and backgrounds well. Information about people's backgrounds, as well as their preferences for their care, was recorded in care plans for staff to refer to. Staff supported people to be as independent as they wanted to be and to take part in activities they were interested in. People were involved in their care plans. Care plans contained accurate information about people and were regularly reviewed so they were reliable for staff to refer to in supporting people. People, their relatives and staff were involved in the running of the care home and were consulted on in various ways.

There was a suitable complaints system in place and details about complaints made, as well as action taken regarding them, was clearly recorded for auditing purposes. People had confidence the manager would resolve issues they raised with them.

The provider was meeting the requirements of their registration with CQC in submitting statutory notifications of incidents such as allegations of abuse.

We observed staff as they worked with people using the service and found that they were treated with respect and dignity. Staff interacted with people in a positive manner and allowed sufficient time for people to express their views and wishes when talking to them.

People we spoke with told us that they felt well cared for at the home. One person told us "We are here because we need to be helped and staff do their job and help us". Another person said "Sometimes the staff make me laugh and sometimes they are too busy to joke around".

We saw that staff interacted with people in a professional yet informal manner and were able to demonstrate an awareness of people's individual support needs.

We saw records of staff recruitment, supervision, qualifications and experience. We saw that the provider had effective recruitment and selection procedures in place and carried out relevant checks when they employed staff. An induction period then followed which allowed new staff to be supervised and supported by the manager and colleagues. Records inspected were seen to be up to date and fit for purpose.