Cherry Tree Care Home

Cherry Trees Care Home is a residential care home providing accommodation and personal care for up to 25 people in one adapted building. At the time of this inspection there were 23 people living at the home.

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

Although people told us they felt safe, we identified some areas of improvement were required. We could not be assured people received their medicines as prescribed or that risks to people were managed and mitigated effectively. Care records including care plans and risk assessments did not provide clear and consistent information in relation to people's needs and abilities. This placed people at risk of receiving inappropriate and ineffective care and treatment which could result in harm.

The provider's quality assurance systems had not always been used effectively to identify areas for improvement.

Appropriate recruitment procedures were in place and there were enough staff to support people's needs. Staff had received training and support to enable them to carry out their role safely. There were appropriate policies and systems in place to protect people from the risk of abuse.

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.

Environmental risks had been considered and acted on where required. There were up to date policies and processes for the management of infection, prevention and control and the provider, management and staff adhered to the latest government guidance.

People were happy living at Cherry Tree Care Home and people and relatives were complimentary about all aspects of the service, describing the management team and staff as kind, caring and responsive. Staff knew the people they supported well and had a good understanding of their needs.

CQC were notified of all significant events that occurred in the service and the previous performance rating was prominently displayed on the premises as per requirements.

The service worked in collaboration with all relevant agencies, including health and social care professionals. This helped to ensure there was joined-up care provision.

Throughout the inspection the management team showed a commitment to wanting to provide people with person centred, safe and effective care. They were open, transparent and responsive throughout the inspection.

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 22 May 2019).

Why we inspected

This inspection was prompted by recent safeguarding concerns and the length of time since the service was inspected.

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 changed from good 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 and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Cherry Tree Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment and good governance. 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.

We found the following examples of good practice.

Visiting had been facilitated, which followed government guidance. A visiting pod had been placed in the garden of the service. This had substantial screening and allowed people to receive visits from loved ones. The registered manager was aware of the recent change to government guidance and was preparing for people to have a designated visitor, who could come into the service once permitted. Clear processes were being established to minimise risks to people. Relatives were also supported to safely visit their loved ones in exceptional circumstances, such as when people were receiving end of life care.

Staff undertook screening of all visitors including temperature checks and a questionnaire, to determine risks posed by visitors. Rapid response lateral flow tests (LFT) were undertaken for visitors before they entered the home. Visitors were provided with Personal Protective Equipment (PPE) and guided to its safe use.

People and staff were regularly tested for COVID-19. Staff had LFT testing twice a week as well as standard Polymerase Chain Reaction (PCR) tests weekly. The registered manager understood the actions they needed to take should any tests return a positive result.

People were supported to understand the measures in place regarding infection prevention and control, to keep them safe.

The home was kept clean. Staff kept detailed records of their cleaning schedules, which included a rolling program of continuously cleaning high touch surfaces, such as light switches, door handles and call bells.

Personal protective equipment (PPE) was available throughout the home. There were signs to remind staff, visitors and people about the use of PPE, the importance of washing hands, regular use of hand sanitisers and appropriate social distancing.

Staff had received specific infection, prevention and control training which included, hand hygiene and donning and doffing PPE. Additionally, spot checks were completed daily by the management team to check staff PPE use, the cleanliness of the service and that social distancing is followed. The management team also completed monthly competency checks of staff to ensure the appropriate use of PPE and that infection, prevention and control measures were being followed as per government guidance.

New admissions to the service were supported in line with best practice guidance. All new admissions were expected to provide recent COVID-19 test results, were further tested by the service following admission and isolated upon arrival for 14 days, to minimise the risk of potential infection to existing people. These procedures were also followed when existing people returned to the home following a hospital stay.

The provider’s infection control policy had been updated and revised during the pandemic so that people were protected in the event of becoming unwell or in the event of a Covid 19 outbreak.

There were sufficient staff to provide continuity of support and ensure safeguards were in place should there be a staff shortage.

The registered manager had a good understanding and knowledge of the staff team and felt they had all worked well together to support people during the pandemic.

Cherry Trees Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to provide accommodation for up to 25 people. There were 23 people living at the home at the time of the inspection.

People’s experience of using this service:

People were happy with the care they received from the staff at Cherry Trees Care Home.

People and family members told us that safe care was provided.

Staff were well trained and received appropriate support and supervision.

People received their medicines as prescribed and infection control risks were managed effectively.

Individual and environmental risks were managed appropriately, and people were protected from avoidable harm.

People's rights to make their own decisions were respected. Staff supported people to make choices in line with legislation.

People were supported to access health and social care professionals if needed.

People's dietary needs were met and people were provided with enough to eat and drink.

Staff were kind, patient and responsive to people's needs. People were treated with dignity and staff respected their privacy.

People knew how to complain and were confident that if they raised concerns, the management would act promptly to address these.

People and staff were fully engaged in the running of the service.

The management team were open and transparent. They understood their regulatory responsibilities.

A quality assurance system was in place to continually assess, monitor and improve the service.

The service met the characteristics of Good in all areas. More information is in the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection:

The service was last inspected in April 2018 where we undertook a full comprehensive inspection (report published June 2018). It was awarded a rating of Requires Improvement.

Why we inspected:

This was a planned inspection based on the previous inspection rating.

Follow up:

There is no required follow up to this inspection. We will continue to monitor all information received about the service to understand any risks that may arise and to ensure the next inspection is scheduled accordingly.

The home was based over two floors, connected by a passenger lift and stairwells. Not all bedrooms had en-suite facilities but there were toilets available on each floor. There was one communal space available for people to socialise.

The inspection was conducted on 27 April and 2 May 2018 and was unannounced.

At the time of the inspection there was not a registered manager in post at the service, there was a manager who had taken over the overall running of the service and was planning to apply to become registered to manage the home. 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 and associated Regulations about how the service is run.

At our last inspection, in April 2017, we gave the service an overall rating of ‘Requires improvement’ and identified a breach of regulation12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to mitigate risks to the health and safety of people using the service effectively. The provider wrote to us, detailing the action they would take to address the concerns.

At this inspection we recorded two breaches of Regulations in relation to Safe Care and Treatment and Good Governance . You can see what action we told the provider to take at the back of the full version of this report.

Systems and processes used to monitor the quality and safety of the service had not been fully effective in preventing the shortfalls found at this inspection.

Risks to people had been assessed; however information within people’s risk assessments and care records was not always followed by staff and guidance from professionals to keep people safe was not always followed.

Action had not been taken to ensure the laundry area was free from clutter or that the flooring was appropriate to mitigate the risk of infection and cross contamination.

Where accidents, incidents, and near misses had occurred there was a process in place which recorded the incident. However, the information provided of the incident/accident or near miss was not always detailed and ideas of how to mitigate risks or prevent reoccurrence had not always been considered, followed up or implemented. Medicines were not kept secure at all times or administered safely.

Consent to care was not always obtained in line with the Mental Capacity Act 2005.

People were protected from the risk of abuse and staff knew how to identify, prevent and report abuse. Staff understood how to keep people safe in an emergency.

There were enough staff to meet people’s needs in a timely way. Appropriate recruitment procedures were in place to help ensure only suitable staff were employed.

People’s needs were met by staff who were competent, trained and supported appropriately in their role. Staff followed the principles of the Mental Capacity Act 2005 (MCA) and sought verbal consent from people before providing care.

People were supported to have enough to eat and drink and had access to health professionals and other specialists if they needed them. Staff worked in partnership with healthcare professionals to support people at the end of their lives to have a comfortable, dignified and pain-free death.

Staff showed care, compassion and respect to the people and people spoke positively about the attitude and approach of staff. There was a relaxed and calm atmosphere within the home. People were cared for with dignity and respect and their privacy was respected.

People were encouraged to be independent and the staff supported people to meet there cultural and spiritual needs.

The service was responsive to people’s needs. Staff demonstrated that they know people well, understood their needs and had knowledge of their likes and dislikes. There was a person centred, individualised approach to care.

People told us they were provided with appropriate mental and physical stimulation through a range of varied activities they enjoyed. People were listened to by staff and their views and wishes were respected. People were encouraged to make decisions about their care.

People and their relatives felt the service was run well. Staff were organised, motivated and worked well as a team. There was a clear management structure in place and the manager had access to appropriate support.

People described an open and transparent culture within the home, where they had ready access to the management and visitors were welcomed at any time.

We identified two breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of this report.

The home was based over two floors, connected by a passenger lift and stairwells. Not all bedrooms had en-suite facilities but there were toilets available on each floor. There was one communal space available for people to socialise.

There was a registered manager in place at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

Not all risks to people were minimised through the use of effective risk assessments which identified potential risks and provided information for staff to help them avoid or reduce the risks of harm.

Not all risks posed by the environment had been assessed or mitigated. For example, doors to corridors and people’s rooms were wedged or hooked open and some bedroom doors did not fully close. This would put people at risk in the event of a fire.

People were supported to receive their medicines safely. However, medicine was not always stored at a safe temperature.

People were protected from the risk of abuse and staff knew how to identify, prevent and report abuse. Individual risks to people were managed appropriately and staff understood how to keep people safe in an emergency.

Appropriate pre-employment checks were completed before new staff commenced working in the home and there were enough staff to meet people’s needs.

A training programme was in place although not all staff had completed all essential training in a timely manner.

Although people were satisfied with the way they were treated we found there was a task driven approach to care and staff did not always respect people’s right to choose when they got up in the morning.

Staff followed legislation designed to protect people’s rights.

People were encouraged to remain independent and their privacy and dignity was respected. People received a varied diet and were supported appropriately to eat. People received mental and physical stimulation in the form of organised activities.

There was a complaints policy in place and people knew how to raise concerns. Where issues had been raised the provider had acted to the satisfaction of the person raising the concern.

We identified breaches of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We also spoke with three visitors to the home. One told us 'I would recommend the home to anyone'. A visiting health professional told us 'I have no concerns with the care provided here'.

We spoke with five care staff, the manager and provider. Staff were well informed of people's needs and records showed people received care as documented in their care plan. We observed staff to be supportive and caring with people.

All parts of the home we viewed were clean and infection prevention and control measures were in place. Cleaning staff knew their duties and records showed these were carried out.

We viewed two staff records. These contained all relevant information and checks carried out before employment commenced. Processes were in place to ensure people using the service, their relatives and health professionals could give feedback about the service. Records showed action had been taken to improve the service.