We carried out a review of the data available to us about Cherry Wood Grange Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Cherry Wood Grange Care Home, you can give feedback on this service.
Cherry Wood Grange is a residential care home providing personal and nursing care to people aged 65 and over. At the time of the inspection there were 54 people living at the service. Care is provided over three floors. The top floor accommodates people with nursing needs, the middle floor specialises in providing care for people with dementia and the ground floor accommodates people with personal care needs.
People’s experience of using this service and what we found
When we last inspected this service in February 2020, we found that some of the systems in place to monitor the quality and safety of the service were not effective and risks to people were not always safely managed.
People had not always been involved in reviewing their care, and care records were not always personalised. A few months after the inspection, a new registered manager was appointed.
The number of safeguarding alerts had reduced since the arrival of the new registered manager. They were working well with external professionals to investigate and resolve outstanding concerns.
The feedback we received during our inspection combined a positive view of the new registered manager and the changes that had been made. One person said, “There is enough staff. There was one staff member who was a bit abrupt, I told the manager and I have not seen her since. I love it here, I am never leaving.” A staff member said, “It’s a lot happier here now. Sometimes staff haven’t always got on at times, but that has been resolved. The management has sorted this out now.”
The new registered manager had put in place systems to monitor the quality and safety of the service, we found these to be effective. The registered manager had introduced measures to learn from incidents and to look at how they could improve the service.
Since the last inspection, people's care records had been updated and reflected people’s needs and preferences. People and relatives were involved in reviewing care.
The way people’s medicine was managed had improved. Audits were in place and carried out routinely. People received their medicines as prescribed and were supported by staff who had received the appropriate training.
The registered manager had started to address the concerns we had raised at our last inspection. They had a practical, person-centred approach which was making a difference to the care people received. Although the registered manager had made positive changes and staff and relatives spoke highly of them, we would need to see a stable management team in the future to ensure improvements are sustained. At the time of the inspection, the provider was recruiting for a clinical lead for the home and told us a person had been recruited and would be starting shortly. A senior nurse was providing an oversight of the clinical care in the interim. The registered manager had a good understanding of the health needs of the people at the service.
Feedback was particularly positive about how well the registered manager was communicating with people, families and staff. One relative said, “Communication is excellent if they have any concerns or need to report anything to us. The care on the dementia floor is brilliant.” Another relative said, “The staff are very good at trying to motivate people. I have seen staff go and sit with people who are sitting on their own to check if they want any company.” Another relative said, “I am impressed with the strategies the staff use. The staff never seem to rush.”
We found the risk from the spread of infection was well managed. People’s care was well-planned, and staff minimised risks to people’s safety. The administration of medicines had improved.
There were enough staff to keep people safe. The registered manager was working well with the staff team to improve staff turnover and morale.
People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. The registered manager promoted a person-centred approach to managing restrictions resulting from the covid-19 pandemic. They communicated well with people and families to explain the restrictions.
Rating at last inspection (and update)
The last rating for this service was requires improvement (published 31 March 2020). After the last inspection, the provider completed an action plan to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
Our data indicated that the provider did not have effective systems in place to keep people safe. We also had concerns about the turnover of registered managers within the provider’s service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. Therefore, we did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
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.
We considered how well the provider had responded to the concerns and breach found at the last inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cherry Wood Grange on our website at www.cqc.org.uk.
Follow up
We will continue to monitor the information we receive about the service, and we will carry out an inspection if we receive any concerning information indicating that people are not safe.
Cherry Wood Grange is a residential care home providing personal and nursing care to 62 people aged 65 and over at the time of the inspection. The service can support up to 65 people.
People’s experience of using this service and what we found
The systems in place to monitor the quality and safety of the service were not effective and had not identified the issues we found at inspection. Risks to people were not always safely managed. We have made a recommendation about risk management.
People’s care records were not always personalised to reflect their individual needs and preferences and relatives were not always fully involved in reviewing care. We have made a recommendation about the care planning process.
Following a specific incident, the service had received support from the Clinical Commissioning Group to improve their processes for the safe management of medicines. At this inspection we found people received their medicines as prescribed and were supported by staff who had received the appropriate training and support to carry out their role. We have made a recommendation about medicines care planning.
Staff were safely recruited. However, we received mixed feedback about whether there were enough staff to meet people’s needs. People and relatives told us staff were kind and caring in their support. Staff knew how to protect people from the risk of abuse.
People were supported to access healthcare services and the service worked closely alongside other health professionals.
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 were supported to take part in different activities and families were welcomed into the service.
People knew how to raise concerns and told us they were confident action would be taken to address their concerns. People were supported appropriately with their end of life care wishes.
The registered manager asked people, relatives and staff for regular feedback. The service put measures in place to learn from incidents and to look at how they could improve the service.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was Requires Improvement (published 27 March 2019) and there was a breach of regulations. The provider completed an action plan after the last inspection to show what they would do, and by when, to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations. The service remains rated Requires Improvement.
Why we inspected
The inspection was prompted in part by notification of a specific incident. The information CQC received about the incident indicated concerns about the management of medicines. This inspection examined those risks.
We have found evidence that the provider needs to make improvements. Please see the Safe, Responsive and Well-Led sections of this full report.
Enforcement
We have identified one breach in relation to the provider’s processes for monitoring the quality and safety of the service. Please see the action we have told the provider to take at the end of this report.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
People’s experience of using this service:
People received care from staff who knew them well. People told us staff were kind, caring in their approach and promoted their independence.
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.
There was a new manager who had been in post since December 2018. The manager had a visual presence. People, their relative’s and staff were positive regarding the management of the service.
The management team had systems in place to monitor the quality and safety of the service provided, and to drive improvements where this was required. The service considered people's feedback and was continuously trying to improve the service.
We received mixed views from people regarding the availability of staff at all times. The manager used a dependency assessment tool and kept staffing levels under review.
Staff and the management team completed a variety of checks. However, some areas for development had not been monitored by the clinical management team. These included the monitoring of people at risk of choking, pressure care and those at risk of inadequate food and fluid intake. The management team agreed to review their approach and make necessary changes.
Staff had received some training relevant to their roles and responsibilities. Further training was planned to ensure nursing staff had the required skills and updated knowledge to meet the needs of people at the end of life.
People were supported to take their medicines in a safe way, but staff did not always have robust details on when to give medicines that were prescribed 'as and when required'.
The management team worked well to lead the staff team in their roles and ensure people
received a good service. People, their relatives and staff told us they were approachable and that their views were listened to.
People had access to a variety of nutritious meals and snacks.
Staff were aware of people's life history and preferences and they used this information to develop positive relationships and deliver person centred care.
We recommended consideration be given to the risk of isolation when planning care for people isolated in their rooms.
There was a varied range of social activities on offer. Staff encouraged people to participate in group and one to one activities of interest to the individual.
Rating at last inspection: This was the first inspection of this service since it registered as a service.
Why we inspected: This was a planned comprehensive inspection.
Improvement action we have told the provider to take:
Please see the ‘action we have told the provider to take’ section towards the end of the report
For more details, please see the full report which is on the CQC website at www.cqc.org.uk