Cherryfield House

Cherryfield House is a residential care home providing personal care to up to 29 people. The service provides support to adults with dementia and physical disabilities. At the time of our inspection there were 27 people using the service.

People’s experience of the service and what we found:

People told us they felt safe with staff and that if they had any concerns they would be listened to by the registered manager. Accidents and incidents were recorded appropriately with any necessary action taken promptly. People were supported by a consistent staff team. The service appeared clean throughout. Ongoing health and safety checks were in place.

Staff had received appropriate training to support them in their role. Staff told us they felt supported by the registered manager. People chose when to have their meal times. There was a varied selection of food available for people. Staff supported people to access healthcare when needed. The service was undergoing a refurbishment programme.

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.

Staff treated people as individuals and with respect. Staff knew people’s likes and dislikes well and also supported people with good humour. Staff supported people to maintain and increase their independence, where possible. Staff involved people in making decisions about their care.

People’s care plans were personalised and reflective of their needs and preferences. People knew how to make complaints. All concerns were responded to and actioned appropriately. People were supported to engage in activities on their own, as a group and in the community.

Staff and professionals gave positive feedback about the knowledge and performance of the registered manager. The registered manager was continuously looking at ways to improve and develop the service. People and staff were engaged in the running of the service and felt listened to.

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 31 January 2018.)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Follow Up

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

This inspection was to check satisfactory improvements had been made and to review the ratings. The provider sent us an action plan that detailed how they would make improvements to become compliant with the regulations. At this inspection we found improvements to the service had been made and the requirement notices had been met.

Cherryfield House is situated in a residential area of Stockport. It provides accommodation and personal care for up to 29 people. It has 21 single and four shared rooms. There are 18 bedrooms that have an en-suite with shower and the remaining rooms have washing facilities. The home is a two storey detached property located in the Edgeley area of Stockport. It has a small front garden and is situated in a residential area within walking distance of a local park. The home was registered to provide nursing care. Car parking spaces are available to the front of the building and public transport links to Stockport town centre are nearby. We found nursing care had not been provided at the home for some time, and the home did not employ nursing staff. Following our inspection the provider submitted an application to cancel their registration for 'treatment of disease, disorder or injury.'

A registered manager was in place. 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.

From our observations of staff interactions and conversations with people living at the service, people told us they felt comfortable and happy living at the service.

There was an established staff team in place, with low levels of turnover. This meant that staff knew the people they provided care and support to very well. There were sufficient numbers of staff on duty to meet people's needs in a timely way. The registered manager worked 'on the floor', which they told us helped determine the required staffing levels and helped to provide good management and support to the staff team.

Staff were recruited following a safe and robust process to make sure they were suitable to work with vulnerable people.

The home was clean and well maintained and we saw staff had access to personal protective equipment (PPE) to help reduce the risk of cross infection.

Procedures were in place to minimise the risk of harm to people using the service. People received their medicines safely and as prescribed by their doctor. The registered manager audited medications procedures. They took action during the inspection regarding the services policies for the safe administration of medications not being appropriately followed by a staff member.

Risk screening tools had been developed to reflect any identified risks and these were recorded in people’s support plans. The risk screening tools gave staff clear instructions about what action to take in order to minimise risks for e.g. for falls.

People’s health needs were monitored, care plans had been developed to incorporate a lot of individual information relevant to each person. People had access to healthcare services Including a district nurse and chiropodist. We received positive feedback from professionals who worked with the home, including a district nurse and a social worker. We saw a range of health professionals had been involved in people's care. Staff spoken with understood the need to obtain verbal consent from people using the service before support was provided.

Staff were receiving regular supervision sessions and appraisal. This meant that staff were being appropriately guided and supported to fulfil their job role effectively. Staff received regular training and support to ensure they had the necessary skills and updates to fulfil their roles and meet people’s needs.

Activities were provided by the staff and visiting entertainers. The service utilised the supply of games and activities to help provide access to events throughout the week. We received mixed responses when we asked people whether there were sufficient activities to keep them occupied.

We saw there was a complaints policy accessible to each person living at the service. The people living at Cherryfield House and visiting relatives we spoke with told us they had no concerns or complaints.

The food looked and smelled appetising and was attractively presented with good size portions. People told us they enjoyed the food but didn’t know what choices they had on offer.

There were systems in place to monitor the quality and safety of the service. We saw appropriate actions were taken in response to any accidents/ incidents and the service had investigated them to consider potential causes of any injuries, and how they might reduce any future potential risk.

During the inspection we noted a capacity issue for the large amounts of historical confidential papers. The registered manager and the registered provider took immediate actions to arrange more suitable storage. With the help of their sister home they transferred records to this home which had larger capacity to archive and safely store their records.

Cherryfield House provides accommodation and personal care for up to 29 people. It has 21 single and four shared rooms. There are 18 bedrooms that have an en-suite with shower and the remaining rooms have washing facilities. The home is a two storey detached property located in the Edgeley area of Stockport. It has a small front garden and is situated in a residential area within walking distance of a local park. The home was registered to provide nursing care. However, we found nursing care had not been provided at the home for some time, and the home did not employ nursing staff. We requested the provider submit an application to cancel their registration for ‘treatment of disease, disorder or injury’, which they did shortly after the inspection. At the time of our inspection there were 28 people living at the home.

We last inspected Cherryfield House on 01 July 2014 when we found the home was meeting the standards for all areas we inspected. At this inspection we identified two breaches of the regulations, which were in relation to the safe management of medicines and governance systems. You can see what action we told the provider to take at the back of this report. We have also made recommendations about reviewing guidance in relation to reviewing processes for determining staffing levels, developing dementia friendly environments and reviewing practices in relation to agreement for shared rooms.

During our inspection we found lots of examples of good practice, and positive and caring support. However, we also identified several areas where improvements were required. The registered manager was responsive to our feedback and had started to take actions to make some of the required changes during our inspection.

There was a registered manager in post. 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.

People living at the home, relatives and visiting professionals all described staff as being kind and caring. There was a long-standing staff team in place, with low levels of turnover. This meant that staff knew the people they provided care and support to very well. People spoke about there being a ‘warm’ environment at the home.

There were sufficient numbers of staff on duty in the day to meet people’s needs in a timely way. The registered manager worked ‘on the floor’, which they told us helped determine the required staffing levels. We found the level of staffing on the night shift varied between two or three staff. The provider told us this was due to people’s vary level of needs. We made a recommendation that the provider uses a documented process to demonstrate staffing levels were based on assessed needs.

Care plans were detailed and person-centred. Sufficient information was provided to allow staff to deliver care to people in accordance with their needs and preferences. People’s social histories were recorded, which enabled staff get to know people.

The service actively identified and recorded complaints, whether raised formally or informally. Actions taken to resolve complaints and concerns were recorded, and written responses were provided to any complaints raised formally. People we spoke with told us they had not raised any complaints, but would feel comfortable doing so if required.

Staff told us they received adequate training to carry out their roles competently. We saw training had been provided in a variety of topic areas including safeguarding, dementia, communication and first aid.

One staff member described taking an approach that showed a lack of understanding and was based on staff convenience rather than being centred on people’s needs and preferences. We raised these concerns with the registered manager who told us the appropriate steps they planned to take to address this concern.

Medicines were stored and administered safely. However, we found there were no written instructions (protocols) for staff to follow in relation to the administration of ‘when required’ (PRN) medicines. This would increase the risk that such medicines were not administered in response to a person’s need for them, and there was evidence of these medicines being administered on a routine basis. The registered manager took action to put PRN protocols in place and sent us evidence of this shortly after the inspection.

We received positive feedback from professionals who worked with the home, including a district nurse and a social worker. They told us they found the home was open minded, and acted upon any advice given. We saw a range of health professionals had been involved in people’s care.

We received mixed responses when we asked people whether there were sufficient activities to keep them occupied. The home had employed an activity co-ordinator who had recently left, and was in the process of recruiting a replacement. During the inspection we saw staff had time to spend talking with people and we saw they arranged a number of ad-hoc activities, including karaoke and a quiz. We saw staff actively encouraged people to engage in these activities and people appeared to enjoy them.

There were systems in place to monitor the quality and safety of the service. We saw appropriate actions were taken in response to any accidents and the service had investigated incidents to consider potential causes of any accidents or injuries, and how they might reduce any future potential risk.

Staff and people living at the home spoke positively about the registered manager. They told us the registered manager was hard working, supportive and approachable. Staff told us they enjoyed their jobs and felt valued for the work they did.

We found records in place to track the frequency of supervision and the training provided were not always accurate or up-to-date. The provider had not ensured their statement of purpose contained the required information. A statement of purpose is a document that provides specified details about the service and is required by CQC.

The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them, visitors to the home and from looking at records.

Is the service safe?

During this inspection visit we observed that people were treated with respect and dignity by the staff and people told us they felt they had everything they needed and were well looked after by staff.

Visiting relatives told us that they were pleased with the care their relative received. One comment was 'Our (relative) is settled and happy. She is well looked after and we are comfortable knowing she is safe when we leave her here or go on holiday.'

During our visit we looked at the premises to see if they were suitable for their intended purpose. We found the premises to be suitable and there was evidence of on-going maintenance at the home. During our visit we toured parts of the home and found all areas to be clean and tidy with no unpleasant smells. Since the last inspection we saw refurbishment had been undertaken in many parts of the home. This included refurbishment of en-suite bathrooms and washing facilities, all bedrooms have had new carpets fitted, all bedrooms had been repainted, had new lighting, new curtains and bedding and new wall mounted T,V's. The dining room and both communal lounges/dinging area have had new curtains.

The environment was clean, tidy and systems were in place to prevent, detect and control the spread of infections.

Visiting relatives told us that the home was always clean and tidy.

Is the service effective?

People living at Cherryfield House had a care file that included assessments of their individual needs and potential risks. The care plan had been developed and implemented to meet those assessed needs. The assessments and care plans were reviewed on a monthly basis and updated accordingly.

Prior to people being admitted into the home, where possible the manager or a senior member of staff visited the person to carry out an assessment of their needs. This meant that people could feel confident that the service could meet their individual and personal care needs when they moved into the home. Where possible people could spend some time at the home having lunch and meeting staff and other people living at the home before a decision was made about moving in. We were told that relatives were encouraged to call in and look around the home at any time without having to make an appointment.

Is the service caring?

The atmosphere in the home felt relaxed, pleasant and friendly. From our observations we saw that care staff had a good understanding of people's individual needs and personalities. We saw that staff were kind and sensitive in their approach to people.

We observed that people looked well cared for and were appropriately dressed.

All of the people we spoke with who were living at Cherryfield House said they were happy and had everything they needed. One person told us 'The care is brilliant, we go out for a lot of walks and I like that.'

When we spoke with visiting relatives we were told that the staff delivered care in a kind and caring way. Some comments were: 'Good care is delivered here,' 'Staff always give people choices where possible' and 'I have never had any concerns.'

Is the service responsive?

We saw that where appropriate the service had accessed advice and care from other health care professionals. For example we saw evidence of visits from the GP, the district nurse, the chiropodist, the opticians and we saw that people attended hospital appointments. This meant the provider sought relevant professional advice and guidance appropriately.

Is the service well-led?

The service was led by a manager who was registered with the Care Quality Commission.

Visiting relatives told us that they felt comfortable talking with the manager. Some comments were: 'Samantha [the manager] is always here and she is very approachable' and 'I have never had any concerns but if I did I would go straight to the manager and I am sure she would sort them out.'

The service worked well with other services to make sure people living in the home received appropriate care and assessments from the right professionals in a timely way.

When we spoke with staff they spoke highly of the support they received from the manager. They told us they received regular supervision and training in the home was good. They also told us they had regular staff meetings and if they had any problem they would go straight to the manager who was always available and approachable.

At our last inspection we found that the statement of purpose needed to be updated as it contained incorrect information. During this inspection visit we saw that the statement or purpose which was also used as a service user guide had been updated and was available for people to access.

The people who lived in the care home could chose to spend time in the privacy of their room if they wanted to, although the majority of people spent time in the downstairs lounge. People who used the service could also have a key to lock their door if they chose and one person who chose not to speak to us locked the door to ensure we did not enter.

The people using the service told us they could decide their daily routines and we observed people to be agreeing to take part in planned activities. The people who lived at Cherryfield House had also consented to having their photograph taken and determined how their room was organised and decorated. One told us 'this is my home now' another said the home was 'comfortable'.

The staff and carers were observed to be unhurried and respectful especially to service users that were confused and forgetful. Staff also sought the opinions of people who used the service with what and when they wanted to eat and drink. One person said that staff were; 'brilliant with me' .

The food was generally considered good by the visitors and people who used the service said there was sufficient choice. Specialised diets were catered for a variety of reasons. When people who used the service rejected what was on the set menu, special efforts were made to cater for their individual preferences.

The visitors were made welcome and felt well informed about the care of the people they visited. They had also said they were supported to understand how to cope with some of the distressing aspects of their relatives' behaviour and consequently felt their relationship with their relative had improved.

The manager has also undertaken a regular 'Quality Questionnaires' with relatives and advocates. It asked relatives to give their opinions on the service and if they understand how to make a formal complaint.

We found an area on non-compliance with a minor impact on people using the service in relation to infection control and hand hygiene. The statement of purpose also needed updating to reflect current organisation and services provided at Cherryfield House The Statement of Purpose is a document that the provider must update and make available to the Care Quality Commission. It should include the aims and objectives of the service provider in carrying out the regulated activity, the kinds of services provided, contact details of the service provider and any registered manager, the legal status of the service provider and details of the registered locations.