Cherrydale

Cherrydale is a residential care home without nursing providing personal care and accommodation to up to 22 older people, including people living with dementia. There were 12 people living at the service at the time of our inspection.

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

There had been improvements to the safety of people’s care, these changes were still being embedded and further improvements were required to the safety of medicine administration and infection prevention and control measures. People told us they felt safe living at Cherrydale. Thorough health and safety checks were taking place on equipment and the environment.

People's needs and choices were assessed and planned for, and their preferences had been considered. Staff were safely recruited and inducted. They had access to training and supervision to ensure they had the skills to support people effectively.

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.

Improvements had been made to quality monitoring systems and work was ongoing to embed these changes with some further improvements required. People's records contained accurate information about their care and support needs. The provider was aware of and acted upon their duty of candour. People and staff were given the opportunity to feed back on the service. The service worked well in partnership with health and social care professionals.

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 4 November 2022) and there were breaches 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 we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 5 September 2022. 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. For those key questions not inspected, we used the ratings awarded at the last inspection of these to calculate the overall rating.

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.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has changed from Inadequate to Requires Improvement. 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 Cherrydale on our website at www.cqc.org.uk.

Follow up

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

Cherrydale is a residential care home without nursing providing personal care and accommodation to up to 22 older people, including people living with dementia. There were 20 people living at the service at the time of our inspection.

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

People were at risk of receiving unsafe care. We observed some unsafe moving and handling practices at the service and environmental risks were not addressed appropriately. People's care records did not always include important information about how to reduce risks associated with their care. There were delays in reporting some safeguarding concerns to the local authority. There were not always adequate staff on duty to meet people’s care needs.

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.

Quality monitoring and management oversight continued to be ineffective at identifying and addressing shortfalls in areas such as medicine administration, health and safety and care planning. Incidents such as allegations of abuse had not always been reported to CQC when necessary, which meant we were unable to check the provider had taken appropriate action in response to these events. The provider had systems in place to enable people living at Cherrydale and their relatives to provide feedback about 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 17 February 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 the provider remained in breach of regulations. This is the fifth consecutive inspection where the provider has been rated inadequate or requires improvement.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 10th December 2021. Breaches of legal requirements were found. We served Warning Notices in relation to Regulation 11 (Consent to care), Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this focused inspection to check the provider 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.

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 requires improvement. 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 Cherrydale 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 continued breaches in relation to consent to care, safe care and treatment, good governance and staffing 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

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 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 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.

Cherrydale is a residential care home without nursing providing personal care and accommodation to up to 22 older people, including people living with dementia. There were 19 people living at the service at the time of our inspection.

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

There were not always enough staff on duty to support people safely. People’s care records did not always include important information about how to reduce risks associated with their care. We observed some unsafe manual handling practices at the service and pressure relieving mattresses were not correctly set to people’s personal requirements. Care plans did not always include up to date information about people.

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.

Best interest decisions were not recorded for people who were assessed to lack capacity in relation to their care. Mental capacity assessments were not always carried out appropriately.

There was a lack of detail in people’s care plans about their end of life care preferences. We have made a recommendation for the provider to review this.

There were gaps in management oversight and auditing at the service. Staff told us they were not always listened to when raising issues. There was a new manager in post who was not yet registered with CQC.

Improvements had been made to the administration of medication and there were suitable infection protection and control procedures in place. People’s needs were assessed before they moved to Cherrydale and access to health professionals was well supported.

People spoke positively about living at Cherrydale and liked the staff who supported them. People were treated kindly and had their privacy and dignity protected.

People were able to do the things they enjoyed and were supported to have contact with people who were important to them.

The provider had systems in place to enable people living at Cherrydale and their relatives to provide feedback about 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

The last rating for this service was requires improvement (published 10 February 2021). Breaches of legal requirements were found in relation to the safe care and treatment of people. 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.

Why we inspected

This was a planned inspection based on the previous rating.

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

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 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, people consenting to care, safe staffing and the governance of the service.

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

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Cherrydale is a care home without nursing for up to 22 older people, including people living with dementia. There were 16 people living at the home at the time of our inspection.

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

Although some aspects of medicines management had improved since our last inspection, the administration of medicines was not always carried out in line with relevant national guidance during this visit. We shared this information with the provider, who agreed to address this with immediate effect.

Known risks to people were managed effectively. For example, people at risk of developing pressure damage were repositioned regularly and people’s weight was monitored where necessary. Systems had been established to help ensure learning took place from adverse incidents, such as accidents and incidents. Personal Emergency Evacuation Plans (PEEPs) had been recorded for all the people who lived at the home.

Standards of hygiene had improved since our last inspection. A cleaner was employed seven days a week and cleaning schedules had been implemented. Staff used personal protective equipment (PPE) appropriately and correctly.

Staff understood their responsibilities in terms of safeguarding and knew how to report any concerns. The manager had used team meetings to discuss abuse and to remind staff about their safeguarding responsibilities.

Safe staffing levels were maintained. Dependency levels were reviewed by the manager each month to ensure staffing levels reflected people’s needs. The provider operated safe recruitment procedures.

A new manager had been in place since November 2020 who had improved the leadership and oversight of the service.

The recording of people’s care had improved and work had begun on developing personalised care plans that accurately reflected people’s needs. Quality monitoring systems were more effective in identifying and addressing any shortfalls. Incidents had been reported to CQC when necessary.

The support and training provided to staff had improved. Team meetings were held regularly and staff shared information about people’s needs more effectively. Residents’ meetings took place and people had been asked for their ideas about the menu and the refurbishment of the home.

Why we inspected

We carried out an unannounced inspection of this service on 25 September 2020. Breaches of legal requirements were found. We served Warning Notices in relation to Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this focused inspection to check the provider now met legal requirements. This report only covers our findings in relation to the Key Questions Safe 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 coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Requires Improvement. 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 Cherrydale on our website at www.cqc.org.uk

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Cherrydale is a care home without nursing for up to 22 older people, including people living with dementia. There were 20 people living at the home at the time of our inspection.

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

People were not always receiving safe care at Cherrydale because the provider had failed to mitigate known risks. For example, one person who had been identified as at risk of leaving the home was able to do so without being observed by staff.

Some people used pressure-relieving mattresses to protect them from the risk of pressure damage. Pressure-relieving mattresses must be set according to the weight of the person using them to function effectively. However, staff did not maintain accurate records of people’s weights, which meant they could not be sure whether their mattresses were set at the correct pressure.

Some people needed to be repositioned in bed by staff to protect them from the risk of pressure damage as they were unable to reposition themselves. However, the daily care logs maintained by staff did not always record whether people had been repositioned.

Personal Emergency Evacuation Plans (PEEPs) had been recorded for all the people who lived at the home permanently. However no PEEPs had been developed for people who were receiving respite care, which meant staff would have no information about the support these people needed in the event of a fire.

People were not adequately protected from the risk of infection because staff did not use personal protective equipment (PPE) effectively. We observed some staff wearing their face masks around their chins, including while they were supporting people. There was no hand towel dispenser in a first-floor toilet. A roll of paper towels next to the toilet was visibly dirty. The smell of urine that was noted at our last inspection was still present in the home’s entrance hall.

People’s medicines were not managed safely. One person had been prescribed pain relief to be administered once a week. We found this had been not administered since 1 September 2020. We made a safeguarding referral to the local authority about this concern.

There were no care plans in place for a person who had moved into the home four days before our inspection. This meant there was no guidance in place for staff about the care the person needed.

The provider’s quality monitoring processes were not effective in identifying and addressing shortfalls. For example, recent medication audits had highlighted errors in people’s medicines administration records but this continued to be a concern at the time of our inspection.

The service had not had a registered manager since April 2019. The current manager had taken up post in April 2020 but had not registered with CQC.

Incidents such as safeguarding referrals had not always been reported to CQC when necessary, which meant we were unable to check the provider had taken appropriate action in response to these events.

Staffing levels had increased since our last inspection. An additional member of care staff had been deployed on each daytime shift. Residents’ meetings had been implemented and people had been asked for their views about the menu and activities. Team meetings took place monthly and staff told us the manager and provider were approachable and supportive.

Why we inspected

We carried out an unannounced inspection of this service on 5 September 2019. 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 safe care and treatment, good governance, staffing and fit and proper persons employed.

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 and Well-led which contain those requirements. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

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 coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has deteriorated from Requires Improvement to 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 Cherrydale 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 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 of legal requirements 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

Cherrydale is a residential care home providing personal care to 22 predominantly older people. At the time of this inspection there were 18 people living at the service. Most of these people were living with dementia.

The home is situated In Camberley. Equipment to support people with limited mobility was available. There were accessible gardens to the rear of the service.

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

Some people were not able to tell us verbally about their experience of living at Cherrydale. Therefore, we observed the interactions between people and the staff supporting them.

There were not always staff available in communal areas to ensure people’s needs were always met. At busy times of the day staff were dispersed in areas of the building which covered three floors. This meant the care and support people were receiving was task driven rather than person centred.

Staff recruitment was not always safe. One staff member had been employed to work in the service before the necessary fit person checks had been put in place. This had the potential to pose risk to people.

The systems in place to manage housekeeping were not effective in making sure all areas of the service were kept clean and free from offensive odours.

People lived in a service which was not always well maintained. Timely action had not been taken to carry out some important property repairs, which had a negative impact on some of the people living in the service. There was damaged woodwork throughout due to the used of equipment. Due to lack of storage space the service was cluttered. For example, boxes stored in a corner of the dining room. A toilet at the entrance to the service had missing tiles under the sink exposing pipework. The toilet roll holder was broken. There were two bathrooms with assistive baths. However only one was in used as the first-floor bathroom had a hoist which was broken, and maintenance records showed it could not be prepared. This reduced the flexibility and choice for people using the service.

The design and layout of the service meant there were restrictions on people’s movement and limitations in the use of equipment. This included a small lift with , limited space for storage. Bland decoration throughout meaning people living with dementia may be disadvantaged in identifying areas of the service.

There were no personal emergency evacuation plans [PEEPS] completed to support staff and emergency services in the event of an incident requiring evacuation. The paperwork was in place but not completed.

The service used an electronic care planning system. However, the information was basic and did not provide an accurate reflection of people's support needs. The information did not demonstrate how risks to people were being managed. Information in reviews was limited. Records reported on the date and name of person reviewing information. They were not meaningful and did not demonstrate people or their advocates had been involved.

People did not have advanced or end of life plans in place to report on their wishes or choices. Care staff understood the importance of supporting people to remain at the service as they approached end of life. Without clear instruction in respect of people’s choices this had the potential to pose restrictions.

The service was recording and reporting on accidents and incidents. They were being logged and summarised, but there was no evidence that the information was analysed for trends or any lessons learned identified. We have made a recommendation for the provider to consider current guidance on analysing significant incidents to identify and respond to patterns or trends.

Medicine systems had recently been reviewed by the GP, manager and pharmacist. Stock of as required medicines [PRN] had been reviewed and where not used for a period of time had been stopped. Medicine records were completed accurately and with enough detail. Staff responsible for medicines management had effective training. Following the inspection, a pharmacist told us they would be providing ongoing support and training for staff.

People told us that staff were kind and caring, staff involved people in their care and made sure people's privacy was respected. Staff worked well together and understood the service's aim to deliver good quality care, which helped people to continue to live as independently as possible. However, staff were concerned they did not always have the necessary time to respond to people’s needs. This was evident during the morning period when staff were engaged in supporting people on upper floors and were not always available in communal areas.

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. For example, there were no best interest meetings taking place where people received medicines concealed [covertly] and where pressure mats monitored a person’s movement. The main entrance had a key pad meaning there were restrictions in how people left the building.

Quality monitoring systems were in place however, these were not always effective. Concerns found at this inspection had not been identified by audits. There had been recent changes in managers. Internal operational managers had not identified, and actioned issues identified at this inspection. The manager had started to review all governance systems and audits and was being supported by the provider. There was evidence issues identified at this inspection had been recognised by the manager and plans were being put in place to address these.

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

The last rating for this service was Good (published 6 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Responsive and Well-led sections of this full report.

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

There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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 inspected Cherrydale on 30 November 2016. The inspection was unannounced. The service was last inspected in December 2013 when it was found to be meeting the requirements of the regulations.

People told us they felt safe at the service and with the staff who supported them. For example, we were told, “Yes I feel safe here,” and a health professional said the community nurse team were, “Quite happy with the home…We have never discussed there being problems with the home.”

People told us they received their medicines on time. Medicines administration records were kept appropriately and medicines were stored and managed to a good standard.

Staff had been suitably trained to recognise potential signs of abuse. Staff told us they would be confident to report concerns to management, and thought management would deal with any issues appropriately.

Staff training was delivered to a good standard, and staff received updates about important skills such as moving and handling at regular intervals. Staff also received training about the needs of people with dementia.

Recruitment processes were satisfactory as pre-employment checks had been completed to help ensure people’s safety. This included written references and an enhanced Disclosure and Barring Service check, which helped find out if a person was suitable to work with vulnerable adults.

People had access to medical professionals such as a general practitioner, dentist, chiropodist and an optician. People said they received enough support from these professionals. Health professionals were positive about care at the service for example we were told, “I feel that the staff at Cherrydale are very caring and the patients seem well cared for and happy in their home. I do not have any worries about my patients who are living there and would be happy to send one of my relatives there.”

There were enough staff on duty and people said they received timely support from staff when it was needed. People said call bells were answered promptly and we observed staff being attentive to people’s needs.

Care was provided appropriately and staff were viewed as caring. For example, we were told; “They provide excellent care. I have never had any grounds for concern,” “(My relative) is always nicely dressed, and her hair is brushed,” and “I am really pleased with it. They are so wonderful with the residents.”

The service had some activities organised. These activities included activities such as board games, keep fit, craft activities and some people had recently attended a church coffee morning.

Care files contained information such as a care plan and these were regularly reviewed. The service had appropriate systems in place to assess people’s capacity in line with legislation and guidance, for example using the Mental Capacity Act (2005).

People were happy with their meals. Everyone said they always had enough to eat and drink. People said they were provided with a choice of meals. People said they received enough support when they needed help with eating or drinking.

People we spoke with said if they had any concerns or complaints they would feel confident discussing these with staff members or management, or they would ask their relative to resolve the problem. They were sure the correct action would be taken if they made a complaint.

People felt the service was well managed. We were told the registered manager was; “Lovely,” “Approachable,” “Nothing gets overlooked,“ and “Nothing is too much trouble for her.” There were satisfactory systems in place to monitor the quality of the service.

People who lived at the home received care, treatment and support from staff that were competent to carry out their role. People spoken with told us they were well looked after. One person said '"My needs are always being assessed. The staff are so attentive."

Infection control practices had improved and people were cared for in a clean and hygienic environment. People told us the home was clean. One person said 'The hygiene levels here are very good. Staff always wear their gloves and aprons when they help me to wash and dress'.

The management of medicines was robust and protected people from harm.

People were protected from unsafe or unsuitable equipment because there was enough equipment to promote independence and comfort of people who used the service.

People were cared for by staff that were supported to deliver care and treatment safely and to an appropriate standard. The provider's statement of purpose was current and kept under review.

People told us the staff were lovely, they were very kind and caring". Relatives told us the care provided at the home was very good and their relatives were well looked after.

People who could express a view told us they enjoyed the food, and that if they did not like what was on the menu, the cook would provide an alternative. Family members spoken with told us that their relative always enjoyed the food provided at the home

The arrangements in place for the control of infection was poor people and others were at risk of harm. Tablets of soap and cloth towels were being used in many areas of the home.

People were given support by the provider to make a comment or complaint where they needed assistance.