Cherry Tree House

Cherry Tree House is a residential care home providing personal and nursing care to up to 18 people. The service provides support to older people, people with a physical disability, younger adults and people who experience mental health difficulties. At the time of our inspection there were 11 people using the service. Accommodation is provided in 3 purpose-built buildings.

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

Significant improvements had been made in the service since our last inspection. The registered manager was an experienced manager who was dedicated to achieving good outcomes for people through person-centred support. The provider was committed to making improvements in the service and had implemented robust governance systems.

People lived in a relaxed, clean environment. Systems and processes were in place to protect people from harm. There were enough staff safely recruited to meet people’s needs. Infection prevention and control measures were in place to help keep people safe. People had their health and well-being needs met. Medicines were safely managed.

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 by caring, skilled and experienced staff who had time to get to know them and how best to support them. Staff supported people to identify their goals and develop their independence.

There was a positive culture within the home and the staff implemented the values of the provider to provide high quality personalised care and support to people.

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 inadequate (published 8 June 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection 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.

This service has been in Special Measures since 31 July 2021. The decision was made to impose conditions on the providers registration to reduce the risk of harm to people. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

The overall rating for the service has changed from inadequate to good based on the findings of this inspection.

Follow up

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

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

Records of restraint were not fully completed with required information such as the duration of the physical intervention or a staff debrief. This placed people at risk of unnecessary or disproportionate treatment.

Medicines were not safely managed, we found gaps in the recording of the administration of medicines and medicines were not always available.

Risks to people did not always have appropriate strategies implemented to protect people and staff from harm.

The service was not consistently working within the principles of the Mental Capacity Act 2005 (MCA) People had not been supported to maximise their decision making and records lacked detail on the information used to determine people’s capacity.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The provider had failed to ensure there was adequate oversight of the service. Quality assurance systems and processes did not identify or address all of the issues found during this inspection.

People and staff were able to feedback on the service. However, relatives were not kept up to date on information and had not been asked to feedback on the service provided.

People were supported by sufficient, trained staff, who had been recruited safely to ensure people were suitable for their roles. The provider undertook appropriate checks with the Disclosure and Baring Service (DBS) and obtaining suitable references.

The provider completed infection prevention and control processes to protect people, staff and visitors from the risk associated with infections and COVID-19.

People's bedrooms were personalised with their belongings, chosen pictures and artwork.

People were encouraged and supported to cook their own meals and people were involved with planning what they would like to eat.

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 inadequate (published 31 July 2021)

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 18, 19 and 25 May 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained the same. The overall rating for this service is inadequate. This is based on the findings at this inspection.

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

Enforcement

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.

We have identified breaches in relation to safe care and treatment, consent to care and oversight of the service at this inspection.

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.

The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Cherry Tree House is a residential care home which provides personal and nursing care for 12 people at the time of the inspection. The service is registered to support a maximum of 18 people.

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

Risks were not identified, managed or monitored to ensure people were safe and protected from harm.

Systems and processes to protect people from abuse and improper treatment were not robust. Staff did not have sufficient guidance in care plans and risk assessments to support people safely.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. Capacity assessments were not always completed for people who were believed to lack capacity.

The provider had not ensured good oversight of the home to care for people safely or learn from when things went wrong. Incidents were not reviewed and audits that were completed did not identify areas of concern.

The provider had not always notified us of important events when required which is their legal requirement to do so.

Staff generally knew people well, had good relationships and knew how to communicate with them.

Staff were recruited safely, and all necessary pre-employment checks had been completed.

People had access to healthcare support when needed.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This service was registered with us on 10 June 2019 and this is the first inspection of this location.

Why we inspected

The inspection was prompted in part due to care concerns shared by external stakeholders. A decision was made for us to inspect and examine those risks.

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 have found evidence that the provider needs to make improvements.

The provider submitted a plan detailing actions they will take to mitigate the risks identified. This is being reviewed currently and ongoing.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, safeguarding service users from abuse and improper treatment, governance and quality monitoring, staffing, respecting service user’s dignity, consent to care and treatment and failure to submit notifications to the CQC, at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.