Archived: Cherry Acre Residential Home

In response to the concerns raised we undertook a focused inspection which was carried out on 27 July 2016 and was unannounced.

We carried out an unannounced comprehensive inspection of this service on 14 and 22 June 2016. Due to continued concerns about the provider’s management of the service, we were unable to give the service a rating. There were still areas of concern in relation to the maintenance of the premises, on-going testing of systems, staff training, the vulnerability of the provider around financial viability and the fact that the provider intended to increase the number of people living at the service after the inspection.

This report only covers our findings in the safe and well-led domains in relation to the concerns raised. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Cherry Acre Residential home on our website at www.cqc.org.uk

Cherry Acre Residential home provides accommodation and personal care for up to 17 older people. The service had low occupancy levels and had not been fully operational since December 2014. For example, at our previous inspection in June 2016, there were only seven people living in the service. At this inspection there were five people living in the service. People receiving care had low needs and were relatively independent and required minimal assistance with their care. The accommodation was arranged over two floors. Staff provided assistance to people like washing and dressing and helped them maintain their health and wellbeing.

The provider had appointed a registered manager. There were audits of the service being undertaken by the registered manager. However, the provider was not supporting the registered manager by providing the necessary recourses in response to premises defects and to deal with the planned maintenance and servicing of the premises and equipment.

The premises were dated, shabby and dilapidated, but the provider only initiated improvements when they were asked to do it by an external body, such as the local authority or regulator. The provider was not able to sustain a level of quality between inspections by managing and monitoring their own service effectively.

The provider was unable to demonstrate how they ensured they monitored the quality of their service against published legalisation and regulations to maintain people’s health and wellbeing and make improvements to the service.

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

The inspection was carried out on 14 June 2016 and was unannounced. We announced a re-visit to the service on 22 June 2016 to meet the manager who was on leave on 14 June 2016.

At a previous inspection on 20 April 2015, we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Health and Social Care Act 2008 (Registration) Regulations 2009. The breaches were in relation to the safe storage of medicines and the potential risk of accidents through poor maintenance of the premises. Also, the provider was not complying with the condition of their registration with CQC by not employing a registered manager at the home.

We carried out a follow-up inspection on 8 December 2015 to check what actions the provider had taken to meet the regulations. At the inspection on 8 December 2015, we only looked at the safe and well led domains. We found that the provider had taken steps to meet the regulations highlighted in our inspection report of 20 April 2015. However, at the inspection on 8 December 2015 we found further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a continued breach of the Health and Social Care Act 2008 (Registration) Regulations 2009.

The breaches identified on 8 December 2015 were in relation to the fire system not being routinely maintained by a competent person to mitigate the risk of system failure and the lack of an up to date legionella and gas test certificate. Also, the provider continued to be in breach of their registration conditions, as they had not employed a registered manager at the service. We had asked the provider to send us action plans of how they were going to meet the regulations and also they had been required to submit a pre inspection information questionnaire (PIR), but these were not received by CQC. The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

At this inspection, we found that the provider had taken steps to ensure the fire system was tested by a competent engineer and they had an up to date legionella test certificate. They had also started the process of registering a manager with CQC as required by their conditions of registration. The provider told us they had sent the Commission their PIR. However there was no record on the CQC system of this being received and the provider had no record of it being submitted. The provider had also sent us confirmation that they had carried out the required work to meet the regulations breached from our last inspection in December 2015 in instead of an action plan. However, we continued to have concerns about the provider’s ability to sustain meeting the regulations after this inspection. We could see that there were still areas of concern in relation to the maintenance of the premises, on-going testing of systems, staff training, the vulnerability of the provider around financial viability and the fact that the provider intended to increase the number of people living at the service after the inspection. This meant that we considered the service had not been fully operational. These issues coupled with the low levels of occupancy meant that we have not been able to gather enough evidence to rate the service at this inspection.

We have made a recommendation about staff training.

At the time of our inspection there had not been a registered manager employed at the home since 24 January 2011. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the home. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the home is run. However, the provider had appointed a manager who was in day-to-day charge of the service and they had applied to CQC to become the registered manager.

The manager carried out audits and reported on the quality of aspects of how the service was run to the provider. However, the provider had not consistently ensured that issues highlighted during audits by the manager were dealt with. We could see that the same maintenance issues appeared on audits because the provider had not dealt with them appropriately. The infection control audits in relation to the cleaning of the service had not been kept up to date. At the time of the inspection the maintenance issues and infection control did not pose an immediate risk to people and the manager had found some work around solutions to the staff training issues despite not being supported by the provider.

At this inspection we raised concerns with the provider about a potential rodent infestation in the rear garden. We also raised this issue with Medway Council. The provider sent us confirmation that they were taking action. However, Medway Council and the Infection Control Lead from the Local Clinical Commissioning Group subsequently carried out a series of visits to the service and shared their findings with the Commission. We have reported on this in more detail in a follow-up report.

The provider had not consistently provided resources the manager needed to maintain staff training and some staff had not be paid fully.

People we spoke with told us they were secure and safe in the service. Staff understood their responsibilities in relation to protecting people from abuse and showed a good understanding in identifying and preventing abuse.

Staff continued to respond to incidents in the home to maintain people’s safety. Incidents and accidents were recorded and checked by the manager to see what steps could be taken to prevent these happening again. Staff understood what changes they needed to make after incidents had occurred to keep people safe and equipment was provided to assist staff to manage risk. People’s health and wellbeing was supported by prompt referrals and access to appropriate medical care.

Risks were assessed by staff to protect people and guidance was provided to staff about managing individual risks. People were involved in assessing and planning the care and support they received.

Staff were available to people in the right numbers and with the right skills to meet people’s needs. Recruitment policies and procedures were in place that had been followed to ensure only staff suitable to work with people who needed safeguarding were employed.

There was a policy about how staff should respond to emergency situations. Managers ensured that they had planned for foreseeable emergencies, so that should they happen again people’s care needs would continue to be met.

Staff followed a medicines policy issued by the provider and their competence was checked against this by the manager.

The manager involved people in planning their care by assessing their needs when they first moved in and then by asking people if they were happy with the care they received. The manager and staff team were committed to the people they provided care to and they were kind and compassionate in their approach and nature.

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

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

The manager ensured that staff underwent checks before starting work at the home. For example they checked a person's character by carrying out Disclosure and Barring Service checks (DBS). This was formerly known as a criminal records check.

During our inspection we saw that staff delivered the care outlined in people's care plans. For example we observed that staff ensured people were safe when they were lifted because staff used specialist equipment. We found that staff had been trained to carry out these task. Also to ensure people's safety, where two staff were required to carry out a task, we observed that two staff were available.

Procedures for dealing with foreseeable emergencies were in place and staff were able to describe these to us. The manager understood how care would be continued in the event of a foreseeable emergency occurring. Staff had access to support and advice at all times from a senior member of staff.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). We saw that people's rights were protected because the manager understood how to support people to make decisions in their best interest.

The service was kept clean and free from infection because the manager ensured that there was a cleaning schedule in place and that this was followed.

There were systems in place for making regular audits of the risks of providing the service and safety of the premises. Incidents and accidents were monitored. The manager had made changes as a result of learning from incidents and these had been put into practice.

The manager ensured that there were enough staff to meet people's needs. We found that that they had ensured that staff had the required skills and knowledge to care for people in a safe way.

Is the service effective?

People had an individual care plan which set out their care needs. We found that the manager used an assessment system that was appropriate for people living with dementia. People's relatives had been fully involved in the assessment of people's health and care needs when appropriate. Relatives and other key people had been involved in supporting decisions that had been made in people's best interest. For example, when people lacked capacity to make decisions about their care for themselves. People's care plans were reviewed regularly to check they were still effective. During our inspection we saw staff delivering the care outlined in people's plans. When people fed back about the service they talked positively about the care provided at the service.

Is the service caring?

We found that people were treated with respect and their dignity was maintained. People appeared relaxed and comfortable with the staff that supported them. We observed that people had a positive relationship with staff. Staff took time to chat with people about day to day matters. All of the people we talked with during our inspection were happy with the care people had experienced. People told us that the staff were caring. One person said 'We are looked after very well'. Other people said 'X has been very well cared for'. We observed that staff were attentive to people's needs and responded positively when people required their support. Staff we talked with told us that people were well cared for.

Is the service responsive?

The manager ensured that people's care plans were reviewed regularly. There was a nominated person in charge of the service with the required training and authority to manage how the service was delivered. The manager or their deputies were available via telephone for further advice when needed.

We found that the manager asked people about their experiences from the care and treatment they had received. People told us that the registered manager had consulted them about the quality of the service.

Is the service well-led?

The provider continually monitored areas of risk in the service and made regular checks on quality. There was evidence that the provider learnt from incidents. Changes had been made to minimise the risks of incidents occurring again.

People's care was assessed, planned and managed. Staff were aware of people's care needs. The manager had ensured that the resources required to deliver the regulated activities were available.

Staff were trained and had received an induction when they joined the service. Team meetings enabled staff to express their views about service quality and they were able to raise issues that concerned them.

The manager ensured that daily checks of the quality and safety of the service were carried out. Regular reviews of people's care plans took place which ensured their needs were being met.

At the time of our inspection there was no registered manager in post.

At the time of our inspection the provider did not have a registered manager in post. There was a manager who was supported by a deputy manager.

We spoke with three people who lived in the home and one visitor. People told us that that they were happy in the home and felt that staff understood their needs and listened to what they had to say. Comments included, "I can't fault them at all" and, "Everyone is very good".

We observed that staff treated people with dignity and respect. Staff were polite and interacted well with people and understood the importance of asking people for their consent before any care and treatment was given.

People were provided with appropriate care and support that met their needs and promoted their wellbeing.

Medication procedures had improved and now safeguarded the people who lived in the home.

The environment was maintained to meet the needs of the people who lived in the home.

Improved records and record keeping met with the requirements of regulation.

People we spoke with all told us that they were generally happy in the home and that they felt that staff worked very hard. They told us that they thought the staff were kind and caring. Relatives told us, 'All in all, people are well looked after',' The girls [staff] here are lovely' and 'I can visit whenever I want'. Overall we saw that staff were patient with people who lived in the home and understood their individual needs.

There was no information in the care records that showed people's ability to give their consent, make choices or participate in decision making about the care and support they required. Where people had made a decision or choice this was not always respected.

The assessment, planning and delivery of care was not coordinated so that it promoted safe effective care, treatment and support.

People were not protected against the risks associated with the unsafe use, administration and management of medicines.

We found that there were some areas of the home that did not promote the safety of the people who lived there. Relatives told us that they thought the home needed some attention in places.

Not all records could be located or were available at the time of the inspection.