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Inspection carried out on 22 October 2019

During a routine inspection

About the service

Cherriton provides accommodation and support for six adults who have learning disabilities. It is run by MacIntyre Care who provide support services to people across the country. There were five people living there at the time of the inspection.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people. The service used some medication to be given when needed; this was monitored carefully and administered in a person-centred way, in line with positive behaviour support principles.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service applied the principles and values of Registering the Right Support and other best practice guidance. This helped ensure that people who used the service lived as full a life as possible and achieved the best possible outcomes that include control, choice and independence.

The building design fitted into the residential area and with other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff did not wear anything that suggested they were care staff when coming and going with people.

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

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.

Most people living at Cherriton were unable to vocalise their opinions of the support they received. They required a lot of support for personal care. However, people's support focused on them having as many opportunities as possible to enjoy positive experiences. Staff were motivated and worked in a positive way to develop trusting relationships. The service enabled people to pursue leisure interests and maintain relationships with families and friends.

There were enough staff employed to ensure people were supported. We observed staff engaged in positive support which was warm and caring. Staff we spoke with told they were supported well and received training and supervision.

Support plans identified the needs of people and plans contained enough person-centred information to identify and meet the preferences of people receiving care.

People had access to healthcare and the registered manager worked closely with other agencies to ensure successful outcomes were achieved.

Systems were in place to ensure the safety and wellbeing of people. These included systems to protect people from the risk of abuse and receive their medicines safely.

Rating at last inspection

The last rating for this service was Good (last report published 14 April 2017).

Why we inspected

This was a p

Inspection carried out on 10 March 2017

During a routine inspection

This was an unannounced inspection carried out on 10 March 2017. We also visited the provider’s offices on 14 March 2017 to look at records.

The manager of the service had applied to be the registered manager and was going through the process at the time of the inspection. 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.

Cherriton provides accommodation and support for six adults who have learning disabilities. It is run by MacIntyre Care who provide support services to people across the country.

The house is a detached property in a residential area of Rock Ferry. It fits in with the local neighbourhood and is in keeping with the principle of supporting people to live ordinary lifestyles in their local community. Shared space includes a lounge, dining room, kitchen, bathroom and two accessible shower rooms. Outside, an enclosed back garden provides seating, and parking is on-street at the front of the house. Each of the people living at the house has a large bedroom of their own, some of which are located downstairs.

We last inspected Cherriton in June 2015. At that inspection we had concerns that the provider did not meet the requirements of the Mental Capacity Act 2005 (MCA) and with how the service managed their quality assurance systems. At this inspection we found that these areas had improved along with the rest of the service provision.

The home employed adequate staff in order to meet the needs of the people who lived there. The staff were supported by the manager and senior support worker to do their jobs well. They had access to regular training, support and supervision.

The premises were cleaned and well maintained. We saw that the equipment was regularly checked to ensure that it was safe for use. We saw that there were plans in place to improve some areas of the home.

The manager and staff team had a good understanding of the Mental Capacity Act and saw that it was safely applied to ensure that people were cared for lawfully.

The staff were kind and caring and we saw many examples of how they respected the individuality and dignity of the people who lived in the home. Relatives spoke very highly of the staff and the manager and the care that their family members received.

The home was well led and the manager and senior support worker worked hard to maintain systems and processes to ensure that people received good care in a caring and safe environment.

We saw that risk assessments were in place and were updated regularly to keep people safe. Medicines were managed well for everyone who lived in the home. The manager monitored the systems and processes well and made sure that standards were maintained and took action when it was required.

Inspection carried out on 19 June 2015

During a routine inspection

This was an unannounced inspection carried out on 19 June 2015.

A registered manager was in place at Cherriton. 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.

Cherriton provides accommodation and support for six adults who have learning disabilities. It is run by MacIntyre Care who provide support services to people across the country.

The house is a detached property in a residential area of Rock Ferry. It fits in with the local neighbourhood and is in keeping with the principle of supporting people to live ordinary lifestyles in their local community. Shared space includes a lounge, dining room, kitchen, bathroom and two accessible shower rooms. Outside, an enclosed back garden provides seating, and parking is on-street at the front of the house. Each of the people living at the house has a large bedroom of their own, some of which are located downstairs.

We last inspected Cherriton in January 2014. At that inspection we looked at the support people had received with their care, welfare and nutrition, we also looked at whether people were safe, the support provided to staff and how the quality of the service was assessed by the provider. We found that the provider had met regulations in these areas.

The registered provider did not meet the requirements of the Mental Capacity Act 2005 (MCA). They had applied for and received Deprivation of Liberty Safeguards (DoLS) for people who needed them, however people's capacity to make a particular choice was not always assessed. You can see what action we told the provider to take at the back of the full version of the report.

Quality assurance systems were in place but did not operate effectively enough to ensure people received a safe, effective caring and well led service. You can see what action we told the provider to take at the back of the full version of the report.’

Care plans provided sufficient information to inform staff about people’s support needs. This included information about their health, personal care and activities they enjoyed.

People received the support they needed with their nutrition, however this support was not always provided in a way that promoted their dignity.

Medication practices were not always safe. People received their medication on time and it was stored correctly. However, stock control systems were not robust enough to prevent the possibility of medication being mis-managed.

Staff had received training and understood their role in identifying and reporting any potential incidents of abuse. They also had a good understanding of whistle blowing procedures and their role in dealing with any complaints received. The registered provider responded appropriately to safeguarding and complaints.

A system was in place for recruiting new staff to work at Cherriton. This included carrying out checks to help ensure the person was suitable to work with people who may be vulnerable.

There were enough staff available to support people with their daily lives. Staff had received the training they needed to support people safely and well. Staff knew the people living at Cherriton well and were able to respond to their non-verbal methods of communicating. Records were stored safely and were maintained and up to date.

Inspection carried out on 10 January 2014

During a routine inspection

We spoke with a range of people about the home. They included the registered manager, staff members, residents and relatives. We also asked for the views of external agencies in order to gain a balanced overview of what people experienced living at Cherriton.

We used a number of different methods to help us understand the experiences of people who lived at the home. This was because the residents had complex needs and were not able to tell us about their experiences.

We spent time in all areas of the home, including the lounge and the dining areas. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed. We observed staff using various ways of communicating with people, including pictures, objects and symbols which were used to assist people to be more independent and make choices. We saw that staff interacted positively with people and talked to them in a kind and respectful way, altering their communication styles in order to meet individual needs.

Following the visit we spoke with relatives by phone. They told us they were regular visitors to the home and described the standard of care as very good.

We looked at staff training records and supervision arrangements. Staff told us they felt supported, had regular meetings with the provider and their training was kept up to date.

There were a range of audits and systems in place to monitor the quality of the service being provided.

Inspection carried out on 31 January and 4 February 2013

During a routine inspection

We used a number of different methods to help us understand the experiences of people using the service, because the people who used the service had complex needs which meant they were not able to tell us their experiences. We spoke with three relatives who told us they were very happy with the service their relatives received.

We looked at the healthcare records that showed the service sought advice and input from other health and social professionals to ensure any proposed treatments were in people’s best interests. The care plans were person centred and identified the holistic needs of the people who used the service.

Cherriton was pleasantly decorated and furnished in a ‘homely’ style with pictures and photographs displayed on the walls. Bedrooms had been personalised and reflected the interests and styles of the people who lived

Training records showed all staff employed by the service had gained the National Vocational Qualifications (NVQ) Levels 2 or 3 in care. The provider offered all newly appointed staff a comprehensive induction training package that also included orientation to their specific place of work and mentorship by experienced members of the staff team.

Relatives told us if they were not happy with the service their relative received they would speak to the manager. Records showed the provider had a system in place to encourage the staff team to support people who used the service to raise issues or complaints on their behalf.

Inspection carried out on 14 December 2011

During a routine inspection

We spent time in the communal areas with people who lived at Cherriton.

We observed care workers supporting people in an affectionate and respectful manner. They were attentive to people’s physical and emotional needs offering physical and verbal comfort to them when they became distressed.

We observed people who used the service being treated in a sensitive and respectful manner.

People who used the service appeared to be relaxed and comfortable with the care workers supporting them.

We requested information about Cherriton from Wirral Department of Adult Social Services (DASS) contracts and commissioning team, no information was provided.

We requested information about Cherriton from Wirral Local Involvement Networks (LINKs), no information was provided.