Cherry Tree House

About the service

Cherry Tree House is a care home providing personal and nursing care to up to 81 people. The service provides support to older people, and people living with physical disabilities or dementia. At the time of our inspection there were 52 people using the service.

Care is provided across three floors and provides general nursing, dementia nursing and specialises in complex dementia care. All bedrooms are ensuite and there are a variety of communal areas on each floor including living and dining areas, adapted bathrooms and gardens.

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

Care and plans were comprehensive, personalised and contemporaneous that detailed people’s current care needs and included how to safely manage any identified risks. Medicines were managed safely by trained staff and people received their medicines as prescribed. There was a safeguarding policy in place and staff knew how to identify and report any concerns. The home was very clean and followed appropriate infection control practices. We have made one recommendation about monitoring records and one recommendation about staff recruitment.

There was a mandatory training programme in place and staff received supervision and ongoing support. Feedback about food and drink was mixed and kitchen staff were aware of people’s preferences and individual risks around food and drink. People were supported to access healthcare and the service facilitated appropriate and timely referrals to other agencies and 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. We observed people making real choices throughout their day and they decided how they spent their time; what they wanted to do and when.

People received compassionate care from kind and caring staff. Staff we spoke with talked about people in a kind and compassionate manner and were passionate about providing good care. People were treated with dignity and respect from attentive and responsive staff.

People received person-centred care. Care plans provided guidance on how to support people, in accordance with their preferences, choices and communication needs. Activities were in the process of improvement and enrichment, and we observed people enjoying the new activities. Complaints were actively responded to.

The new senior management team had made significant improvements throughout the home since the last inspection and there was a culture of continuous development for the home. There was clear leadership and visions and values for the service. Management systems, such as audits and quality assurance, were robust and were now actively used to monitor and 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 5 July 2022).

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.

At our last inspection we recommended that the provider review their recording processes around the administration of prescribed creams. We also recommended the provider review staffing arrangements. At this inspection we found the provider had made improvements

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 to good based on the findings of this inspection.

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

Recommendations

We have made one recommendation about monitoring records and one recommendation about staff recruitment.

Follow up

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

Cherry Tree House is a residential care home providing personal and nursing care to up to 81 people. The service provides support to older people, and people living with physical disabilities or dementia. At the time of our inspection there were 78 people using the service.

Care is provided across three floors, with two floors providing general nursing care and one floor providing specialised care for people living with dementia. All bedrooms are ensuite and there are a variety of communal areas on each floor including living and dining areas, adapted bathrooms and a shared garden, kitchen and laundry.

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

The systems in place to ensure oversight and drive ongoing improvement were in place but had not been effective in resolving all of the issues found at the last inspection or identifying further concerns found at this inspection. The management team were responsive to feedback and took immediate action to investigate our findings and address any shortfalls and provide assurances. The providers track record at Cherry Tree House did not demonstrate that the required improvements could be effectively made and embedded at the service.

People did not always receive the right support to maintain a healthy diet and care records were not robust enough to have oversight that people were receiving the correct diet. People were having their needs assessed but changes were not always readily identified in people’s care records. Staff spoke positively about the training they received, but this was not always evident in how we observed people being cared for. People’s bedrooms were spacious; and people were able to personalise them. There was a programme to redecorate the home in place.

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

People’s experience of being cared for by staff varied and not everyone was consistently treated with dignity and respect. We observed some positive interactions between staff and people, but other interactions which were task focused, or where the support people needed was not readily given. People were not always supported to remain as independent as possible.

People did not always receive person-centred care and we found examples where care was planned and delivered in a staff and task focused way. A new programme of wellbeing activities had been implemented and the wellbeing coordinator was keen to support people’s emotional wellbeing. People were supported to have visits from friends and families, but it was not clear that people had been supported to maintain these contacts as much as possible, and some people were unclear about how the current guidance was being followed. People had care plans in relation to end of life. Those receiving end of life care had advanced care plans which detailed specifics about people’s plans for end of life and use of medicines to keep people comfortable.

Systems of checks and maintenance were in place for equipment. There were individual and generic risk assessments, and incidents and accidents were investigated. Staff were being recruited using safer recruitment practice and work to improve recruitment was ongoing. Staff were not effectively deployed throughout the day to meet the needs of people and the home used a high number of agency staff. We have made a recommendation about the dependency tool used to assess staffing levels. People were receiving their medicine as prescribed but we have made a recommendation in relation to the recording of administration of creams. The home was clean and staff used PPE as required.

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 05 February 2021) and there were breaches of regulation. This service has been rated requires improvement for the last three consecutive inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service and to follow up on action we told the provider to take at the last 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.

Enforcement and Recommendations

We have identified breaches in relation to delivery of individual personalised care; treating people with dignity and respect; the meeting of people’s dietary needs; and the oversight and leadership at the home.

We have also made recommendations in relation to medicines and staffing.

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.

Cherry Tree House is a nursing home which provides personal and nursing care for up to 81 people who require this type of support. At the time of the inspection 68 people were using the service. Care is provided across three different floors, with one floor specialising in providing care for people living with dementia. Each floor has a number of communal areas, including a dining room and kitchenette, and a variety of lounge areas. All bedrooms are en-suite and there are adapted bathrooms to support people with specific needs in relation to personal care

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

There were environmental checks and risk assessments in place. We noted some shortfalls in how risks were identified and managed, and recruitment processes were not always robustly followed. People had individual care plans and risk assessments but they did not always contain enough specific detail. People and families told us they felt safe and that they had seen improvements from the new management team. Staff were very positive about how the provider had managed during the COVID-19 pandemic and felt safe at work.

People were assessed and supported to access the health care support needed although we noted some shortfalls. Most permanent staff were aware of the needs of people who required additional support with food or fluids, but care plans must include more details in this area. Staff told us the induction process and training covered everything they needed within their roles. 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 policies and systems in the service supported this practice.

There were systems for auditing and checking the quality of service, but these were not sufficiently robust to have identified the issues we noted during the inspection. There was a new management team in place and staff spoke positively about how the service was being organised and run. Most family members knew who the registered manager was and felt able to raise concerns and ask questions of the management team.

For more details, please 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 January 2020) and there were a number of 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 not enough improvement had been made and the provider was still in breach of regulations. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about the safe care and treatment of people, the maintenance of a safe environment and the management of the home. As a result, we undertook a focused inspection to review the key questions of safe; effective; and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, effective 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 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 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 the management of individual and environmental risk, oversight of risk to ensure the quality of the service and robust recruitment processes at this inspection.

We have identified breaches in relationship to Regulation 12 (Safe Care and Treatment); Regulation 17 (Good Governance) and Regulation 19 (Fit and Proper persons employed). 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.

Cherry Tree House is a nursing home which provides personal and nursing care for up to 81 people who require this type of support. At the time of the inspection 79 people were using the service. Care is provided across three different floors, with one floor specialising in providing care for people living with dementia. Each floor had a number of communal areas, including a dining room and kitchenette, and a variety of lounge areas. All bedrooms are en-suite and there are adapted bathrooms to support people with specific needs in relation to personal care.

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

People and relatives told us they felt safe and cared for at the home. Medicines were being safely managed, stored appropriately and suitable systems for recording were in place. Recruitment processes were in place, but these had not been sufficiently robust to ensure staff were safe to support vulnerable people and some staff had been dismissed following concerns about their performance. People and relatives expressed concerns about the consistency and level of staffing. We observed that people were asked to wait before being supported and there had been complaints and safeguarding investigation following delays in people receiving support.

People were not always supported to have maximum choice and control of their lives and staff did not always supported them in the least restrictive way possible and in their best interests. People were generally supported to access health care services in a timely manner and the home worked closely with an out of hours medical service. There were, however, a few occasions when people had not received the correct support. Staff had received training and support to undertake their role, although the reported experience of this varied across the staff team.

People and relatives told us staff were kind and caring. We observed that regular members of staff knew people well but were very busy and task orientated.

The quality of care plans varied across the home and not all care plans were person-centred. We saw that there were instances where care plans had not been followed, which has resulted in safeguarding investigations, complaints and staff being dismissed. The home investigated and responded to complaints, although not everyone was satisfied with the response given. The home had one activity co-ordinator in place at the time of the inspection, but this was not sufficient to meet the needs of everyone living at the home. The registered manager understood how to meet the needs of people at the end of life, but these care plans were often not in place until a person was at this stage, meaning that they were possibly less able to contribute their views due to ill health.

There was a registered manager in place, however there had been changes in the management of the units since our last inspection and new unit managers were in place. Systems were not in place to ensure a consistent approach to care planning and ensure people’s care needs were being met in line with their needs and preferences. Systems to develop a positive culture and supportive environment were not effective to ensure that all staff had positive experiences of being supported.

Rating at last inspection

The last rating for this service was requires improvement (published 15 January 2019) and there were two 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 insufficient improvement had been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns we had received in relation to staffing and the delivery of safe care and treatment. A decision was made for us to inspect and examine those risks

Enforcement

We have identified three breaches of regulation. These relate to regulation 9 (person centred care) as people were not always receiving care in line with their preferences ; Regulation 12 (Safe care and treatment) as there was not always sufficient staff who knew people well, care plans and treatment needs were not always being safely followed and recruitment processes were not always sufficiently robust; and Regulation 17 (Good Governance) as there was not sufficient oversight to have ensured improvement had been made since our last inspection and ensure lessons were learnt across the home.

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 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.

At the time of the inspection Cherry Tree House was accommodating 73 people in one building across 3 units. The Bramhall and Romiley units supported people needing nursing care, whilst the Marple unit, on the middle floor, offered specialist dementia nursing care. All bedrooms were single occupancy with en-suite toilet and shower facilities and each unit had its own living and dining areas.

At the time of inspection, the service did not have a registered manager 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. The previous registered manager had left in early autumn 2018 and the new manager had recently commenced employment at Cherry Tree house and was in the process of registering with the CQC.

At the last comprehensive inspection, undertaken in November 2016, the service was rated as overall good. At that inspection we rated the well led section as requires improvement because we found a breach of the Health and Social Care Act 2008 regulation 17 (Regulated Activities) Regulations 2014 (good governance). This was because at that time there was a new manager in post and we needed to see consistent and sustainable good practice in the well led domain.

A focused inspection was completed in October 2017, following concerns raised in relation to the management of choking risk. At that inspection we looked at the effective and well led domains. We found the home was good in the effective domain but continued to require improvement in the well led domain.

At this inspection we looked to see if the service continued to be good overall and whether improvements in the well led domain had been made. We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to regulation 12 safe care and treatment; and regulation 17 good governance. You can see what action we told the provider to take at the back of the full version of the report.

There was a high use of agency staff at the time of inspection. People, family members and staff all identified this as an area of concern. There were processes in place to improve consistency of the agency staff used, however our observations during inspection, and feedback we received indicated that not all agency staff had a good understanding of the needs of the people living at Cherry Tree House. Following inspection, we received information from the management team that all positions had been recruited to and the use of agency staff was being significantly reduced.

People’s medicines were not always safely stored, and records were not accurately and consistently maintained across the home.

Policies, procedures and governance were not sufficiently robust to ensure good practice and consistency throughout the home.

The home was clean and tidy. People were able to personalise their bedrooms and there were a variety of areas for people to use within each unit

The service had a new manager, deputy and unit managers in place. They told us of the plan they had to create consistency and stability within the home and drive improvement.

Recruitment procedures were in place which ensured staff were safely recruited. Some staff had not completed all required training.

Staff were aware of their responsibilities in safeguarding people from abuse and could demonstrate their understanding of the procedures to follow so that people were kept safe.

Individual and environmental risk assessments gave staff guidance on how to minimise and manage identified risks. Health and safety checks were carried out and equipment was maintained and serviced appropriately.

The requirements of the Mental Capacity Act 2005 were being met. However, there were a number of ‘low priority’ Deprivation of Liberty Safeguarding assessments outstanding for local authority assessment.

Care records contained information about people’s care needs but varied in terms of quality and consistency of paperwork being completed. There were a range of monitoring charts being used to ensure people’s support needs were being met.

There were a range of activities on offer at the home. People appeared to enjoy the activities available.

There was a system for recording and dealing with complaints. We saw that these were being investigated. Incidents, accidents and safeguarding were being reported and analysed to look for themes and trends and develop learning and prevent reoccurrence.

Quality assurance systems were in place. A variety of checks and audits were in place to drive improvement.

The service had the previous CQC ratings on display within the home and on the provider website as required.

This focused inspection was carried out over one day on 12 October 2017 and was unannounced.

The inspection was prompted by notification of an incident following which a person using the service died. This incident is subject to an investigation and as a result this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of the risk of choking. This inspection examined those risks.

We last inspected the service in November 2016 where we identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The identified breach was because a new manager was in post and we needed to see evidence that longer term, consistent and sustainable good practice and management of the service had been maintained. During this inspection we looked to see if the consistent management of the service had been maintained. We found the breach in regulation had been met.

The service had a registered manager in place. A registered manager is a person who has been 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.

Staff spoken with and training records seen confirmed that appropriate and regular training was taking place to make sure staff had the appropriate knowledge and skills to carry out their job roles effectively.

Staff were receiving formal supervision on a consistent basis.

We saw records that identified individual people at risk of potential choking and, since the incident the registered manager had reviewed each care plan to make sure all relevant information was available to support staff should a choking incident occur, including clear directions on the action to take based on professional medical advice.

At the time of the inspection new medical equipment (suction machines) had been provided in the event of a choking incident.

In addition, introduced on the day of our inspection was a Clinical and Care Equipment Training Booklet for Nurses and Senior Assistant Practitioners (SAP’s).

The service was last inspected in May 2016 following which the service was rated overall as ‘Inadequate’ and was therefore placed in ‘special measures.’ Services placed in special measures are kept under review and, following any immediate action taken, will be inspected again within six months. This inspection was carried out to check if sufficient improvements had been made to the service.

Cherry Tree House is a purpose built three-storey care home owned by London and Manchester Healthcare (Romiley) Ltd. It provides nursing care for up to 81 people. Accommodation is provided across three units. Bramhall Unit, situated on the ground floor, and Romiley Unit, on the third floor, catered for people who needed nursing care. Marple Unit, which predominately supported people living with dementia, was situated on the first floor. All bedrooms are single occupancy with ensuite toilet and shower facilities. The home has a secure garden and off road parking is provided. There were 51 people living in Cherry Tree House at the time of our visit.

The service had a registered manager in place. A registered manager is a person who has been 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.

Sufficient numbers of appropriately trained care staff and qualified nursing staff were available to support people and help meet their assessed needs. People who used the service, who we spoke with told us, “We seem to have more staff about now” and “Yes, I think there are enough staff.”

Staff meetings and formal staff supervision had been taking place on a regular basis since the last inspection of the service and this was confirmed by staff we spoke with and records seen.

Medicines had been effectively managed since the last inspection of the service.

People told us they enjoyed the food on offer. We saw meals were fresh and looked and smelled appetising. People were offered choices of various alternative foods and beverages on each of the units.

Fluid and diet charts were being completed in enough detail to accurately monitor what people were eating and drinking. Any advice from healthcare professionals such as nutritionists was being recorded in relevant documentation.

Each person using the service had an up-to-date care plan, risk assessments and other associated documentation in place.

The service employed activity co-ordinators on each unit who actively engaged with people individually or in groups. There were activities on offer throughout the day to suit peoples tastes, including visiting performers.

The premises were kept secure, with keypad entry to each unit. Deprivation of Liberty Safeguard (DoLS) assessments had been completed and authorisation requested for those people with limited capacity and unable to use the keypad entry system. The communal areas and the bedrooms we looked at were clean. Policies and procedures to minimise the risk of infection were followed.

Where people who used the service lacked capacity to consent to care and treatment the appropriate steps were taken to protect their rights.

We observed some good interaction and communication between staff and people who used the service.

We saw that the service had a written complaints policy and a procedure which was visible at the entrance to each unit.

Systems were in place to monitor the quality of service and to identify where improvements to the quality of care could be made.

At the last inspection in May 2016 we rated the well-led domain as ‘inadequate’ as we found the management of the service was not, at that time, well-led and staff lacked clear management leadership. At this inspection we found the provider had taken action and was now meeting legal requirements. Although we saw improvement had been made, we have not rated this key question as ‘good’, to improve the rating to ‘good’ would require a longer term track record of sustainable good practice.

Our inspection was brought forward because we had received concerns relating to staffing levels and the high number of safeguarding alerts raised with the local authority by health and social care professionals.

When we previously inspected this location in December 2015, we identified seven breaches of the Health and Social Care Act Regulated activities 2008 (Regulated Activities) Regulations 2014. We found systems to monitor the quality of care were lacking; consent was not always sought; care plans were not reviewed regularly and did not identify how risks would be managed; there were insufficient staff who had not been recruited safely or provided with adequate supervision, and medicines were not properly managed. During this inspection we found that there had been improvement in some areas but we found further issues of concern and further improvements were still needed.

When we visited the service there was no registered manager 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. The service had recruited a new manager, who was present throughout the inspection, and informed us that she had begun the process of registration.

Cherry Tree House is a purpose built three-storey care home owned by London and Manchester Healthcare (Romiley) Ltd. It provides nursing care for up to 81 people. Accommodation is provided across three units. Bramhall Unit, situated on the ground floor, and Romiley Unit, on the third floor, catered for people who needed nursing care. Marple unit, which predominantly supported people living with dementia, was situated on the first floor. All bedrooms are single occupancy with ensuite toilet and shower facilities. The home has a secure garden and off road parking is provided. There were 56 people living in Cherry Tree House at the time of our visit.

We identified multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, of which some were continued breaches of regulations following our inspection in December 2015. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

There had been a high number of safeguarding concerns investigated by the local authority, and we found that staff did not always report issues of concern, leaving people at risk.

There were insufficient numbers of suitably qualified staff to meet the needs of the people who used the service. People told us that at weekends the service was often short staffed, and we saw that during the weekend prior to our inspection only two care staff had been on duty on one of the units.

There had been no staff meetings since our last inspection and staff had not been supervised. One Unit manager told us “Supervision has taken a back seat”.

Medicines were not managed effectively. We found numerous recording errors, some medicines out of date, a confusing ordering and storing system, and evidence of missed medicines. Medicines had been lost and consequently not provided. We saw that the home was conducting a review of the medicines procedures and would introduce a new cycle or ordering and dispensing stock.

People told us they enjoyed the food on offer. We saw meals were fresh and looked and smelled appetising.

Fluid and diet charts were not always completed in enough detail to accurately monitor what people were eating and drinking, and advice from nutritionists was not always recorded.

At out last inspection we noticed that people on the Marple unit had not been consulted following a decision to provide only decaffeinated coffee. When we returned this time, they were still denied the choice.

We saw care plans contained numerous errors; notes were inconsistent and did always refer to people’s likes and preferences. Information was missing or out of date in some care plans. However we were reassured to see that the service had recognised that the systems in place to record and store information was not fit for purpose and were in the process of implementing a new system.

There were no effective systems in place to identify the risks to people’s health, welfare and safety. Where issues had been identified, the steps required to deal with these issues had not been taken.

The service employed activity co-ordinators on each unit who actively engaged with people individually or in groups. There were activities on offer throughout the day to suit peoples tastes, including visiting performers. However, on the second day of our inspection the activity co-ordinator on one unit was absent, and no activity had been arranged.

The premises were kept secure, with keypad entry to each unit. The communal areas and the bedrooms we looked at were clean. Policies and procedures to minimise the risk of infection were followed.

Where people who used the service lacked capacity to consent to care and treatment the appropriate steps were taken to protect their rights.

We saw some good interaction and communication between staff and people who used the service, but not all staff were familiar with the people who used the service and did not spend much time with them. Care was taken to ensure that individual’s privacy and dignity was respected.

We saw that the service had a written complaints policy and a procedure which was visible at the entrance to all units. One visiting relative told us that their complaint had been looked into by the service. However, a record of complaints and any actions taken had not been maintained.

The staff we spoke to were confident that the manager was helping to improve the service. We saw that they had begun to implement systems for improving the quality of care.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

We conducted the first part of our inspection late at night. We had received information that concerned us about the standard of care provided to people at night. We found nothing to support these concerns.

People we spoke with told us that they were happy with the care they received and could make some of their own decisions for instance; when they went to bed and when they got up.

We saw that staff interacted well with people using the service and were kind and caring in the way that they delivered care to people. Staff told us that they were well trained and well able to deliver a high standard of care.

The people we spoke with said that there were more than sufficient staff to meet people's needs. One relative told us; 'I have never seen anybody waiting, as soon as they ask someone is there.'

When we spoke to the deputy manager and the owner, they both accepted that for various reasons a robust quality assurance regime was not yet in place.

We spoke to the deputy manager and the owner of the company about records that were kept at the home. Both accepted that there may be some deficiencies in this area as they had been 'Fire fighting since the last manager left.'