Cherry Tree Lodge Private Residential Care Home

Cherry Tree Lodge Private Residential Care Home (referred to throughout this report as Cherry Tree Lodge) is a care home providing accommodation and personal care up to a maximum of 23 people in 1 adapted building. At the time of our inspection there were 20 people living at the service. Cherry Tree Lodge is also registered to provide personal care and support to people living in their own houses and flats in the community. However, at the time of the inspection Cherry Tree Lodge was not proving this service.

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

Various risks including fire and accident and incidents were not always monitored. People were safeguarded from abuse, the systems and processes for this service supported this. Medicines were managed safely. However, training in this area needed to be improved. The environment was clean and tidy, but some infection prevention practices needed improving. People were supported to have regular visitors. Recruitment processes were safe and there was enough staff to safely support people.

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; However, the policies and systems in the service did not always support this practice.

People were not always deprived of their liberty in a lawful and safe way. The necessary assessments were not always carried out in line with the mental capacity act. There was a system in place for staff when they commenced their role. However, not all staff had the relevant training such as medication and fire safety training. People’s care plans did not always contain accurate information and were found to be conflicting. We made a recommendation about this. People and their relatives spoke highly of the assessment process and felt involved. The environment was accessible and suitable for people’s needs.

People and their relatives spoke positively about the staff and the care they received. One person said, “The staff are lovely and caring.” We observed encouraging interactions between staff and people during the inspection and we found people were treated with dignity and respect.

People’s records and care plans were person centred. End of life discussions were taking place when appropriate and this was documented. People’s communication needs were identified, and information was made available to people in an accessible format. A complaints policy and procedure was in place. However, people told us they had no reason to complain and no complaints had been logged. The registered manager was in the process of recruiting an activities coordinator and we observed staff engaging with people during the inspection.

Audits were in place. However, they did not always identify risk and there was little evidence of learning lessons when something goes wrong. There was no evidence of people and their relatives taking part in feedback or satisfaction surveys. Following on from the inspection the registered manager has now implemented this to ensure people’s voices are heard. Staff worked in partnership with various agencies to support people and staff meetings were taking place. Staff and visiting healthcare professionals spoke highly of the registered manager.

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 outstanding (published 4 February 2019).

Why we inspected

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

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.

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

The registered manager and provider have been responsive to the feedback provided during the inspection and has implemented changes to improve the quality and safety of the service.

Enforcement

We have identified breaches in relation to risk management, staff training, mental capacity and good governance. We have also made a recommendation in relation to modified diets.

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

This comprehensive inspection took place on 8 January 2019. The inspection was unannounced.

Cherry Tree Lodge Private Residential Care Home (referred to throughout the report as Cherry Tree Lodge) is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Cherry Tree Lodge is also registered to provide personal care and support to people living in their own houses and flats in the community. However, at the time of the inspection Cherry Tree Lodge was not providing this service.

Cherry Tree Lodge provides accommodation and personal care for up to 23 older people, mainly people living with dementia. It is a small, family run care home located on a main bus route on the outskirts of Rawtenstall town centre. There were 22 people living in the home at the time of the inspection.

The service was managed by a registered manager who was also a director. 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.

At the last inspection of 26 July 2016, the service was rated as good. At this inspection, the overall rating has improved to outstanding; this was due to the excellent way in which the service was led and the commitment from staff to deliver high quality, responsive and compassionate care.

Throughout our inspection, we found the registered manager and staff were committed to the continuous improvement of the service and passionate about their work. They were dedicated to making people feel valued and improving people’s care and self-esteem. Evidence showed they followed best practice and developed positive links with other organisations to influence care and to attain better outcomes for people living at the home.

The philosophy and values of the home were known to staff and followed without exception. ‘Live, love and be loved’ and ‘You are never too old’ were embedded into the day to day experience of the home. Staff told us the registered manager led by example to ensure people received high quality, personalised care. People told us they were made to feel cared for, welcomed and involved. Without exception, everyone spoken with made positive comments about the management of Cherry Tree Lodge and said they would not hesitate to recommend the home to others.

A stable and enthusiastic staff team was in place at all times. Staff had been safely recruited and received the induction, training and support necessary to enable them to deliver effective care. There were enough staff available to meet people’s needs in a way which met their preferences and promoted their independence. The registered manager saw the recruitment, retention and development of staff knowledge and skills to be of vital importance in providing people with excellent care and the feeling of safety. Staff felt valued and had time to spend with people and their relatives without being rushed. Staff enjoyed working at Cherry Tree Lodge.

People made very positive comments about the staff and were more than happy with the care they received. They described staff as exceptionally kind and caring and enthusiastic. People told us staff regularly went out of their way to help them. We observed staff interacting with people and their relatives in a meaningful and caring way; this made people feel they mattered to the staff who supported them. We observed a strong, family orientated service where staff were encouraged to demonstrate highly respectful and caring attitudes towards the people they supported. We observed lots of smiles, hugs and laughter. The service provided specialised care to ensure people's end of life was as comfortable, dignified and pain free as possible.

The home was full of activity, fun and laughter; people were engaged in varied, stimulating and meaningful activities which met their individual interests. Throughout our inspection, we observed staff engaged in conversation or in group and individual activities with people. Our observation confirmed that staff had clearly developed good relationships with people in the home and with their visitors.

The home had developed links with a wide range of community based organisations and there were examples of how this had helped to improve people’s quality of life. People and staff in the home were very involved in supporting their local community and excellent links had been developed with local schools and nursery children; evidence showed this had improved people’s lives and awareness of each other.

People told us the staff respected their privacy and were warm and respectful in their attitude towards them. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff fully understood the importance of acknowledging people’s diversity, treating people equally and ensured that they promoted people’s rights.

Care plans and risk assessments were person centred and provided guidance for staff on how to provide safe and effective care. We were told staff always made prompt and appropriate referrals to external professionals to ensure people’s health needs were met.

People told us they felt safe. Staff had received training in the protection of vulnerable adults and knew what action they should take if they suspected or witnessed abuse. Lessons were learned from any accidents, incidents or safeguarding matters. People received their medicines when they needed them from staff who had been trained and had their competency checked. Without exception, people told us they enjoyed the food provided.

The decoration and furnishings of the home provided people with a safe, comfortable, clean and calm environment. Good practice advice had been considered when making improvements to the home, particularly for people living with dementia. We observed people moving freely throughout the home and were welcomed and supported by staff wherever they chose to spend their time.

Quality assurance systems were robust and used to make improvements in the home. People had a wide range of opportunities to provide feedback on the care provided. Feedback from people living in the home and their relatives was extremely positive.

Cherry Tree Lodge provides accommodation and personal care for up to 23 older people (including people living with dementia). Cherry Tree Lodge is also registered to provide personal care and support to people living in their own homes but at the time of the inspection was not providing this service. It is a small, family run care home located on a main bus route on the outskirts of Rawtenstall town centre. There were 22 people accommodated in the home at the time of the inspection.

At the previous inspection on 8 January 2015 we found the service was meeting all the standards assessed.

The service was managed by a registered manager who was also the owner. 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.

All the people, their relatives, visiting professionals and staff we spoke with had nothing but praise for the service and the quality of life people experienced. People living in the home told us they felt safe and considered staff were always available to support them when they needed any help.

Recruitment processes and procedures ensured new staff were suitable to work with vulnerable people. There were appropriate arrangements in place in relation to the safe management of people’s medicines.

Staff had a good understanding around recognising the signs of abuse and had undertaken safeguarding training. They were clear about their responsibilities for reporting incidents in line with local guidance. Staff had received training on the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). This meant they had knowledge of the principles associated with the legislation and people’s rights. Staff understood the importance of gaining consent from people and the principles of best interest decisions.

Risks to people’s health, welfare and safety were managed very well. Risk assessments were in place in relation to pressure ulcers, behaviours, nutrition, falls and moving and handling.

Staff had a good understanding of people’s personal values and needs and people’s personal choices were respected. Staff received training to ensure people’s rights to privacy, dignity, independence and choice were respected. We found staff were very respectful to people, attentive to their needs and treated people with kindness, care and respect. People told us staff treated them kindly and like family.

People felt their needs were being met appropriately. Staff were well trained and well supported and committed to provide a high quality of care. People’s care and support was kept under review and referrals had been made to the relevant health and social care professionals for advice and support when people’s needs had changed. This meant people received prompt, co-ordinated and effective care.

People told us they enjoyed the meals. We noted the atmosphere was relaxed with friendly chatter throughout the meal. Staff were aware of people’s dietary preferences, the support they needed and any risks associated with their nutritional needs.

We found people lived in a clean, safe, pleasant and homely environment. All areas were tastefully decorated and furnished to a high standard and appropriate aids and adaptations had been provided to help maintain people’s safety, independence and comfort.

Staff had been trained in End of Life care. This meant people could be confident their dignity, comfort and respect was considered at the end of their lives. People using the service and staff were offered emotional support during and after bereavement.

People had a detailed person centred plan which provided staff with good insight into people's personal routines and preferences. The information was reviewed at regular intervals.

People were able to participate in a range of suitable activities and entertainments. People were supported to keep in touch with family and friends.

People were very happy with the way the home was managed. People were involved in the running of the home and were kept up to date with any changes. The registered manager was committed to providing high quality care and worked in partnership with other organisations to drive improvements across the care sector and improve relationships with other professionals.

There were effective systems to assess and monitor the quality of the service to ensure any improvements needed were recognised and the necessary action taken to implement any changes.

At the last inspection of 23 July 2014 we asked the registered provider to take action to make improvements to the standard and the cleanliness of the environment.

During this inspection we spoke with the deputy manager and the housekeeper. The registered manager was unavailable but we contacted her following our visit. We also viewed cleaning schedules and undertook a tour of the home.

We found all work identified at our last visit had been completed and there were systems in place to help identify when any improvements were needed.

We found all areas were well maintained, comfortable and clean. There were records to support regular cleaning and maintenance of all areas. We spoke with the housekeeper who had been employed following the last inspection. She told us she was aware of her role and responsibilities. The housekeeper had received appropriate infection control training and was the designated 'lead' person.

The deputy manager told us senior staff had attended infection control training. The registered manager told us training for all other staff would be completed by March 2015.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

During this inspection we spoke with six people using the service and with one visitor. We spoke with one member of care staff, a cook and the deputy manager. We also spoke with a visiting health professional. We viewed records which included, three care plans and daily care records, maintenance and servicing records, minutes from meetings, cleaning records and various policies and procedures. We spoke with the registered manager on her return from leave the following week.

We considered the evidence we had gathered under the outcomes. This is a summary of what we found:

Is the service safe?

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We were told no applications had needed to be submitted. We were told staff had undertaken training to help them understand their responsibilities with supporting people to make their own decisions. Policies and procedures were also available.

Assessments of any risks were recorded, managed and kept under review. This would help to keep people safe from harm.

People had access to a range of appropriate, well maintained equipment to safely meet their needs and to promote their independence and comfort. Staff had received training to ensure they were competent to use the equipment safely and properly.

People told us they were happy with the cleanliness of their bedrooms. However, we were concerned about the cleanliness of other areas. Care staff were allocated domestic and laundry duties on a daily basis. There were cleaning schedules for them to follow although it was not clear whether these had been followed. We were told there were no formal audits to monitor the standards of cleanliness in all areas of the home. A compliance action has been set in relation to this. The provider must send us an action plan advising how they will ensure the standards of cleanliness and infection control will be monitored and met.

Is the service effective?

People told us they were involved in discussions about their care and kept up to date with any changes. One visitor said, 'I am kept up to date with any changes or problems'. Reviews were carried out by staff, to respond to any changes in people's needs and to ensure the level of care was appropriate. However, changes to people's health and well-being were not always promptly recorded in the care plan.

People's health and well-being was monitored and appropriate advice and support had been sought in response to changes in their condition. We found the service had good links with other health care professionals to make sure people received prompt, co-ordinated and effective care. A visiting professional told us staff were very good at communicating any changes to people's needs.

During our visit we observed staff treating people in a kind, friendly and respectful way. We observed people being offered choices and being supported in a way that respected their privacy and dignity and encouraged their independence. Staff told us communication between the team was effective. One member of staff said, 'We get to know what people like' and another said, 'We are kept up to date'.

Is the service caring?

People told us they were happy with the care and support they received and said they could raise their concerns with the staff. Comments included, 'I'm happy here, everyone is friendly', 'The staff are lovely', 'I have my own routine and staff respect this' and 'I can do as I choose; they help me anytime I need'.

We observed staff interacting with people in a pleasant and friendly manner and being respectful of people's choices and opinions.

Is the service responsive?

We found people's needs were assessed by suitably experienced staff, prior to admission to the home, to determine whether they could be looked after properly.

The care plans contained information about people's preferred routines, likes and dislikes which would help staff to look after them properly and help ensure people received the care and support they needed and wanted. We found staff were aware of people's care and support needs but the information in the care plans was not always reflective of the care people received.

We were told staff were responsible for arranging activities and entertainments on a daily basis and external entertainers also visited the home. People told us there were a number of activities such as arts and crafts, church services, baking and sing-a-longs. People commented, 'It's a bit quiet sometimes', 'I enjoy my own company and I watch TV in my room; I join in at mealtimes', 'We chat with each other and staff join in' and 'I do my own thing really; there is not a lot to do that I am interested in'. We observed good one to one interaction between staff and some of the people living in the home.

Is the service well-led?

The registered manager (who was also the owner) was responsible for the day to day management of the service. The manager was registered with the Care Quality Commission (CQC).

People were encouraged to express their views and opinions of the service during annual customer satisfaction surveys and during day to day discussions with staff and management.

We were told there had been no complaints made about this service. Some people said they could talk to the staff if they were unhappy. Comments included, 'I don't want to make a fuss', 'I have no concerns about things here; I would probably tell my daughter if I had' and 'I'm happy enough. Some things could be better but I don't want to complain'.

The service had introduced new additions to the care recording system since our last visit; we were told the system was still under review. We were concerned the system made it difficult to review people's care and support needs, staff and other professionals, were not able to easily access a detailed picture of each person, changes to care and support needs were not always recorded at the time of the change. Also it was not clear how people using the service, or their relatives, would be able to review and agree the content of the care plan. We discussed our concerns with the deputy manager at the time of the inspection visit and with the registered manager on return from her leave the following week.

There were systems in place to assess and monitor how the home was managed and to monitor the quality of the service in areas including care planning, medication and staff records. There was evidence these systems identified any shortfalls and that improvements had been made. However, there were no systems to monitor the standards of cleanliness and infection control and we had found shortfalls in this area. We asked the provider to take action to improve this area.

Any incidents and/or safeguarding concerns had been reported to the appropriate agencies. Staff were aware of the procedures for reporting any concerns about poor practice.

People's health and well-being was monitored and appropriate advice and support had been sought in response to changes in their condition. We found the service had good links with other health care professionals to make sure people received prompt, co-ordinated and effective care.

People told us they enjoyed the food. Comments included, "The food is very good" and "We can have an alternative to the menu; they are very accommodating".

We found all areas of the home to be bright, safe and comfortable. People told us they were happy with their rooms. One person said, "I have a lovely room; it's clean and bright".

People told us there were enough staff to meet their needs. Comments included, "I press my bell when I need help and they always come" and "Sometimes I have to wait if they are very busy but they let me know". We spoke with three staff who told us they received the training needed to look after people properly.

People were able to express their views of the service and were kept up to date and involved with any decisions about how the service was run.