Cherry Holt Care Home

Cherry Holt Care Home is a purpose-built residential care home providing the regulated activities of personal and nursing care to up to 52 people. The service provides support to older and younger adults and adults with physical disabilities. At the time of our inspection there were 47 people using the service. Support is provided across two floors with a large lounge on the ground floor.

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

Risks were not consistently managed or monitored. Medicines were not always managed safely. Staff were recruited safely and there were enough staff deployed to meet people’s needs. The registered manager reported safeguarding concerns to the local authority in a timely manner. We were assured that the provider’s infection prevention and control policy was up to date.

Internal quality assurance processes were not always effective in monitoring the service which meant improvements were not always made. Staff, people, and their relatives were encouraged to share their views. The registered manager understood their responsibility to be open and honest with people and had acted when things went wrong. The provider worked in partnership with others.

People's needs were assessed however we found some assessments lacked detail to ensure staff had the correct information to support people safely. Referrals to some health and social care professionals were not always made in a timely manner. The premises and environment were under refurbishment therefore did not always meet the needs of people. The registered manager had highlighted gaps in training prior to our inspection. Specialist training had been sought and booked to ensure people received effective care and support. People were supported to eat and drink enough to maintain a balanced diet.

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.

People's communication needs were assessed and documented within care plans. However, we found inconsistencies with how these needs were managed. People were supported by staff who had a good understanding of each person’s individual needs. Staff supported people to follow their interests and hobbies. End of life wishes had been discussed and documented within care plans.

People and their relatives told us, staff respected people’s dignity and independence. People’s individual choices were fully respected. People told us, and care records demonstrated, people had been given a choice of who they would like to help support them. People were encouraged and supported to express their views.

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 outstanding (published 22 February 2020). Since our last inspection there has been a change in both the management and ownership of this service.

Why we inspected

The inspection was prompted in part due to concerns received about nursing care, infection control and the management of medicines. A decision was made for us to inspect and examine those risks.

The overall rating for the service has changed from outstanding to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well-Led section of this full report. You can see what action we have asked the provider to take at the end of this full report.

During our inspection the provider took significant action to address the concerns we found to mitigate risks. Risk reduction measures implemented during our inspection were found to be effective in managing the risks we identified.

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

Enforcement

We have identified breaches in relation to medicines, management of risk and quality monitoring at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Cherry Holt Care Home provides nursing, personal care and accommodation to up to 52 older people, in one purpose built two storey building. There were 51 people living at the service at the time of our inspection.

People’s experience of using this service

Staff and the registered manager, most of whom had been at the service for several years, cared passionately for people. Staff went out of their way to ensure people were comfortable and could continue to enjoy the independence and relationships they valued. People and their relatives experienced affection and patience at all times and were enabled to feel at home in an extremely welcoming, vibrant and inclusive environment.

Feedback from people, their relatives and a range of external professionals was exceptional regarding the compassionate, affectionate and sensitive approach of staff. People had formed extremely strong bonds with staff members they knew well.

Staff knowledge and implementation of best practice was excellent. Additional training was provided to ensure staff at all levels increased their knowledge base and were better able to identify and act on people’s needs. The registered manager and senior staff ensured this was done in consultation with external professionals. They contributed to, shared and rolled out best practice which had a positive impact on people who used the service, and adult social care providers in the area. The service and individual staff had regularly won awards for their approaches to infection control, skin integrity and nutrition and hydration.

There was a creative and proactive approach to healthy eating. This involved themed days and evenings, and a high degree of involvement by people who used the service.

End of life care was outstanding, with proactive, timely and sensitive approaches to the planning of care and excellent working relationships with external professionals. People’s preferences were respected and their families supported at a difficult time to make decisions and to memorialise people in the way they wanted.

Activities were varied and extremely well resourced, by staff who had a passion for understanding what made each person different. There were creative and diverse group activities as well as bespoke one to one activities.

The service was exceptionally well-led. The registered manager continued to drive a range of improvements and initiatives which continued to have positive impacts on people’s health and wellbeing. They were regarded as a leader in best practice across a range of fields and were respected by their staff. Likewise, they were supported by a passionate, caring team of staff at all levels who shared a common understanding and appreciation of people’s individualities and needs.

Feedback regarding the registered manager was consistently outstanding, with them described as a leader and innovator.

Extremely strong community links were in place, ensuring people who used the service felt an active, contributing part of the community.

People were included in the running of the service. Their feedback was sought at resident/relative meetings, individual review meetings or surveys. People and their relatives knew how to raise and issues or concerns.

Records were accurate, up to date and person-centred. Clear systems were in place for the review and audit of all aspects of the service.

Medicines were managed safely, in line with best practice, by well trained and confident staff. The premises were well maintained and appropriate health and safety checks were in place. Emergency procedures and contingency plans were in place.

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

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 13 December 2016). There was also an inspection on 10 June 2019 however, the report following that inspection was withdrawn as there was an issue with some of the information that we gathered.

Why we inspected

This is a planned re-inspection because of the issue highlighted above.

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.

This inspection took place on 3 August 2016 and was unannounced.

Cherry Holt residential home is situated in the market Town of Retford and is registered to provide accommodation for up to 52 people who require nursing or personal care. At the time of inspection 52 people were using the service, meaning that the home was full.

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.

The staff understood their role in keeping people safe. People who used the service and those supporting them knew who to report any concerns to if they felt they or others had been the victim of abuse. Risks were assessed and any accidents and incidents were investigated so that steps could be put in place to avoid reoccurrence. There were enough staff with the right skills and experience to meet people’s needs. Medicines were stored, administered and handled safely and people received their medicines as prescribed.

People were supported by staff who had received the training and supervision they needed to support people effectively.

People had consented to the care that they received. The registered manager applied the principles of the Mental Capacity Act 2005 (MCA) and Deprivations of Liberty Safeguards (DoLS), so that people’s rights were protected. People were asked for their consent before care and support was provided and this was respected.

People were able to choose what they ate and spoke positively about the food they received. When needed, people’s food and fluid intake was monitored so they could be assured that they had enough to eat and drink.

People’s healthcare needs had been assessed and were regularly monitored. The service worked well with healthcare professionals to ensure they provided effective care and support.

People were supported by staff who were caring and treated them with kindness, respect and dignity. People were encouraged to be independent and had access to independent advocacy services should they have required this support. There were no restrictions on friends and relatives visiting their family members.

Staff were responsive to people’s needs and people were supported to participate in activities. People and their relatives were involved with the planning of the care and support provided. Care plans were written in a way that focused on people’s choices and preferences. Regular monitoring of people’s assessed needs was conducted to ensure staff responded appropriately.

A complaints procedure was in place and people felt comfortable in making a complaint if needed.

There was a positive atmosphere within the home and people’s views were considered when making decisions to improve the service. People spoke highly of the registered manager. Processes were in place to check on the quality of the service and the registered manager had clear processes in place to continually improve the quality of the service that people received. The service had recently won awards acknowledging this.

We spoke with two relatives about their views. We observed the support given by staff to people using the service. We also looked at records, including care files for four people and carried out a tour of the building.

We found people received care and support which met their needs. A person told us, 'There is plenty to do and staff are very flexible. They listen to what we want.'

We saw the building was clean, safe and well maintained.

We found that staff were well trained and supported in their role. A person who used the service told us, 'The staff are incredible, very professional and generous with their attention and care.'

We saw that there were systems in place to assess and monitor the quality of service provided.

We found the service was well led.