Archived: Cherry Trees

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, relatives, and the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People did not experience care, treatment or support that met their needs and protected their rights. We judged this had a major impact on people.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. We have judged that this has a major impact on people who use the service.

Where areas of non-compliance have been identified during inspection they are being followed up and we will report on any action when it is complete.

Improvements had been made since the last inspection of the service in the prevention and control of infection. This means the service was mainly safe, clean and hygienic. Equipment in relation to fire safety was well maintained and serviced regularly therefore not putting people at unnecessary risk.

Is the service effective?

Specialist dietary needs were assessed and included in care plans. However, some of the care plans had not been reviewed regularly. Food and fluid charts were not consistently completed. Care plans were therefore not able to support staff consistently to meet people's needs. We have judged that this has a major impact on people who use the service.

Where areas of non-compliance have been identified during inspection they are being followed up and we will report on any action when it is complete.

Is the service caring?

People did not always receive the care that had been planned for them to ensure their safety and maintaining their skin integrity putting them at risk of falling and developing a pressure sores. We have judged that this has a major impact on people who use the service.

Where areas of non-compliance have been identified during inspection they are being followed up and we will report on any action when it is complete.

Is the service responsive?

We found the provider had not addressed serious concerns raised in previous inspection reports in a timely manner. This was in relation to the care and welfare of people who used the service.

Where areas of non-compliance have been identified during inspection they are being followed up and we will report on any action when it is complete.

Is the service well-led?

The assurance system of assessing and monitoring the quality of service provision at Cherry Trees was inadequate. Whilst the audits and checks had identified areas in which improvements were required, the provider had failed to take account of this information to make and sustain improvements to protect people and this put them at risk of harm. We have judged that this has a major impact on people who use the service.

Where areas of non-compliance have been identified during inspection they are being followed up and we will report on any action when it is complete.

On 29 January 2014 we served a fixed penalty notice to Cherry Health Care Limited for failing to have a registered manager in place at Cherry Trees. A fine of '4,000 was paid.

At this inspection we found the provider had not appointed a new manager however a temporary manager was in day to day charge of the home.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with five people using the service, three relatives, and the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People's needs were assessed but not always delivered in line with their individual care plan. We saw that care delivered did not always reflect the care being given. This meant that in some instances individual needs were not being addressed correctly.

We found that people were not always cared for in a clean, hygienic environment. We completed a tour of the home with the manager and saw that some areas were not clean or well maintained. We spoke with the ancillary staff who told us that deep cleaning was not getting done due to there being a staff shortage.

We found that people were not protected from the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. We saw that some people were without their medication due to stock being unavailable in the home.

We found records did not provide staff with sufficient information about medication that needed to be administered on an 'as required' basis. For example we saw several people were administered medication for pain on an 'as required' basis. However, there was no information available to inform staff when, and in what circumstances, this medicine should be given.

Is the service effective?

We spoke with six relatives of people who used the service. They told us they were mostly happy with care and treatment provided. However a number of relatives showed concern about the amount of agency staff that seemed to be used at the home.

We saw meals provided were nutritious and appealing. However, a large proportion of people required assistance to eat and drink; however was saw this was not always provided. Therefore the meals were often left and discarded. This meant that people may not have received sufficient food and fluid to meet their identified individual needs.

We observed that people were given cereals and toast at the same time at breakfast. At lunchtime people were given their main meal at the same time as their pudding. This meant that part of the meal was going cold while the first course was being eaten.

Is the service caring?

We found that some people were at risk of weight loss and this was not always addressed correctly. We saw that some people required food and fluid intake to be recorded. This was not constantly completed and we found gaps where food had not been recorded as eaten or offered. People were not always given a diet to meet their identified needs. For example where people had been assessed as requiring fortified foods and soft diets these were not always offered. We found that some people required assistance to eat their meal, but on some occasions this was not provided.

A large proportion of people were cared for in bed. Staff interacted with these people to provide personal care, but we did not see any social interaction with these people. This meant that they were left alone for long periods of time with not much to occupy them.

We asked staff what the reason was for people remaining in bed and they were unable to tell us and said, 'This is just how it is.' We asked a nurse why this was and they replied, 'If we got everyone up we would not have enough suitable chairs to seat people.'

People's preferences and interests had not always been recorded. Because of this care and support could not always be provided in accordance with people's wishes.

Is the service responsive?

The service was not responsive to the needs of some people. We found a lack of evidence around personal care given to people who were cared for in their rooms. Some people had been identified as being at risk of developing pressure areas. However, we found a lack of records to show the correct care and attention had been given to these people.

We found that there were times when referrals to other professionals had not been followed up and addressed in a timely manner. There was a lack of recording which made it difficult for staff to follow on from each other.

Is the service well-led?

We spoke with relatives of people who used the service and they said, 'We keep bringing in new slippers but they seem to disappear or get lost in the laundry.' Another relative commented on the d'cor'. They said, 'We would not want to sit and stare at the walls that needed painting or holes where wires had been removed and I don't expect my relative to have to look at this.'

We asked the manager about the d'cor and she told us that they had a refurbishment plan in place, but they had been concentrating on bringing the spare bedrooms up to standard. We spoke with people who used the service and their representatives and they told us that the walls had been like this for a long while.

The assurance system of assessing and monitoring the quality of service provision at Cherry Trees was inadequate. Whilst the audits and checks had identified areas in which improvements were required, Cherry Healthcare Limited has failed to take account of this information to make and sustain improvements to protect people and this put them at risk of harm.

On 29 January 2014 we served a fixed penalty notice to Cherry Health Care Limited for failing to have a registered manager in place at Cherry Trees. A fine of '4,000 was paid. We are taking further action with regard to this and will report the details when it is complete.

People experienced care, treatment and support that met their needs and protected their rights. People's relatives said they were happy with the care people received. One relative said they thought the care staff were lovely.

People were protected from unsafe or unsuitable equipment. Staff said they were provided with training in the use of equipment.

People were cared for by sufficient staff, who were supported to deliver care and treatment safely and to an appropriate standard. Staff said their morale had improved since the new management team had been involved.

The provider had an effective system to regularly assess and monitor the quality of service that people received.

In February 2013 concerns were raised by an anonymous whistle blower about the management and care provided in the home. A number of issues were investigated by the provider. These related to equipment, medication and staffing. The provider identified some areas for improvement and put an action plan in place. At this inspection we found that the improvements had been made.