Cherrytrees Care Home

Cherrytrees Care Home is a nursing and residential care home located in Salford, Greater Manchester and is operated by MNS Care Plc. The service can support up to 32 people. At the time of inspection 27 people were living at the home.

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

People felt safe living at Cherrytrees Care Home and received care in line with their needs and wishes. Staff had received training in safeguarding and knew how to identify and report concerns. Any safeguarding issues had been reported in line with guidance. Accidents, incidents and falls were documented and reviewed to identify any patterns and trends, with lessons learned considered to help reduce future risks. Medicines were managed safely by trained staff. People had received their medicines on time and as prescribed. The home was clean, with effective cleaning and infection control processes in place.

People, relatives and staff told us the home was well run and a positive environment. People’s views were sought through regular meetings and via questionnaires. Feedback about actions taken was shared with people and displayed on a noticeboard within the home. Information was communicated to staff through meetings and handovers. The home used a range of systems and processes to monitor the quality and effectiveness of the service provided. Actions plans were used to document any areas for improvement. We found any actions had been addressed timely.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for the service was requires improvement (published 22 April 2021).

Why we inspected

We carried out an announced focused inspection of this service on 12 and 31 March 2021. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve infection, prevention and control practices.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cherrytrees Care Home on our website at www.cqc.org.uk.

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.

Follow up

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

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

We found improvements were required to infection control practices at the home. Appropriate systems were not always in place to protect people from the risk of abuse. People living at the home and their relatives told us the home was a safe place for people to live. There were enough staff to care for people safely and proper recruitment checks were carried out when staff started working at the home.

At the time of our inspection, the home did not have a registered manager, although a new manager had now been appointed and was in the process of registering with CQC. The feedback we received about management and leadership was positive. The current staff team spoke of a positive culture at the home and there were a range of systems in place to seek feedback to improve the quality of 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 Good (published December 2018).

Why we inspected

We looked at infection prevention and control (IPC) measures under the Safe key question. We look at this at all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Initially, our inspection only looked at IPC practices within the home. However, during this visit, we identified other areas of concern and took the decision to change the inspection to a focused inspection looking at the key questions of Safe and Well-led. This report only covers our findings in relation to the key questions which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion (Caring, Effective and Responsive) were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cherrytrees Care Home on our website at www.cqc.org.uk.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Enforcement

We have identified a breach in relation to safe care and treatment at this inspection. Please see the action we have told the provider to take at the end of this report.

Cherrytrees Care Home provides residential and nursing care for up to 32 people. At the time of our inspection there were 21 people receiving nursing care and 9 people receiving residential care. The home provides support to older people, people living with dementia and people with physical disabilities, learning disabilities and younger people.

Cherrytrees is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home has two floors containing bedrooms and bathrooms. On the ground floor there was a large lounge, a dining room and a small quiet room near the entrance. The gardens were secure and accessible from the ground floor. There was a lift and stairs between the floors.

There was a registered manager in post. 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.

We last inspected Cherrytrees in January 2016 when we rated the service as good overall and requires improvement in the responsive domain. This was because we had not seen evidence of people engaging in activities and found some people had not had regular reviews of their care or their medicines. At this inspection we found both these concerns had been fully responded to and have rated the home as good in all domains and overall.

Both people living in the home and their relatives told us they felt safe and secure.

The service protected people from the risk of harm or abuse. Safeguarding policies and procedures were robust and had been followed when required. Staff could identify safeguarding concerns and knew how to raise them appropriately.

Risk assessments had identified the specific risks people needed support to manage, plans had been developed to minimise the potential for harm.

Staff had been recruited safely with all necessary checks being completed prior to them starting to work with people. Staffing was sufficient to support people safely.

Medicines were managed safely. We saw people had received their medicines as prescribed.

Infection control policies ensured people were protected from the risk of infection and cross contamination. Staff were observed to follow good practice when supporting people to meet their personal care needs.

The home responded to accidents and incidents which had been fully investigated so lessons could be learned to avoid reoccurrence. An example of this had been the falls prediction strategy.

The premises and equipment were being well maintained and we saw certificates and relevant documentation of any work that had been completed. These included checks of electrical installation, fire alarms, legionella, gas safety, hoists/slings, the lift and fire equipment.

The home had assessed people's needs thoroughly prior to them moving in. This ensured the home was confident they were able to meet their needs and people received the correct level of service.

Staff had received relevant training which ensured they were able to support people effectively. People who lived in the home told us staff knew what they were doing and were skilled when supporting them. Training for all staff was kept up to date.

People were supported to maintain their nutritional needs. Information provided by health professionals had been included in people's care plans. The kitchen staff were aware who needed different textured diets or thickened fluids. The home had an effective system in place to ensure this advice was followed. In addition the home had provided a nutritional breakdown of food prepared, to highlight foods such as those with a higher protein content that some people might have benefitted from.

The care team continued to work together and cooperated with other organisations including; community based health services, commissioners and social workers which ensured care was provided effectively.

People were supported to maintain their health and wellbeing. Records showed that the home regularly engaged the support of other health and social care professionals to meet people’s needs. In addition there had been some innovative approaches to people's wellbeing which is discussed in more detail in the responsive section of this report.

The home continued to work within the principles of the Mental Capacity Act 2005 (MCA), and were compliant with the associated Deprivation of Liberty Safeguards (DoLS). People had given consent to receive care and treatment and where necessary decisions had been made in line with best interest decision making principles.

People living in the home and their relatives praised the caring and kind support provided by the entire staff team. Staff were observed to interact with people in caring ways which upheld their dignity and privacy.

People's emotional needs had been considered to ensure they were supported to manage their feelings in ways that minimised the need for medication.

People had been supported to maintain their independence. Care plans identified people's skills and the tasks they preferred to complete themselves.

People received care that was personalised and responsive to their needs. Care plans included holistic assessments which identified people's histories, preferences and lifestyle choices.

At the previous inspection there had been concerns about whether people had enough stimulation and activities. At this inspection we found this had been fully addressed. People living in the home told us they engaged in activities. We could see there was a timetable but also evidence of a variety of activities available. In addition, there had been more engagement with the community with entertainers and groups from local schools being invited in to the home.

People told us they felt listened to. There were a variety of ways people could provide feedback and raise concerns with the service. We could see how the home had responded to people's requests.

At the previous inspection there had been concerns about how regularly reviews of care and medicines had occurred. At this inspection we found everyone had regular reviews and medicines were reviewed each month.

People had been supported at the end of their lives to have as comfortable and pain free death as possible. Nursing staff had received training in end of life care, including the use of syringe drivers, which ensured people could be cared for in the home if they preferred.

The home was well led. There was a clear management structure in place. The team had shared values and a commitment to achieving high quality care. Staff said they felt proud to work in the home.

The registered manager was accessible and approachable. People who lived in the home and their relatives praised the management team's commitment and accessibility.

Effective governance systems ensured the manager had clear oversight of the service. Regular audits had been completed and action plans developed which ensured any identified concerns had been addressed. Handover records showed the support people needed and who was to provide this.

Policies and procedures had been developed by the provider. These addressed all areas of regulated activities. Staff were able to look at these on line or in paper format in the office. In addition the home had a 'policy of the week' which was printed and displayed in the staff areas. Staff spoken to said they found this useful.

There was a business continuity plan with clear information to support people take the appropriate action in the event of an emergency. This would be especially useful when the manager was not present.

People's confidential information had been stored securely and recent changes had been made to ensure compliance with the General Data Protection Regulation (GDPR).

The home continued to work in partnership with other organisations and attended forums where knowledge and experience were shared. We could see this had added some value to the quality of care provided.

Cherrytrees Care Home is registered with the Care Quality Commission to provide accommodation for persons who require nursing or personal care for a maximum of 32 people. The home is located in a residential area of Salford next to a public park with ample parking available for visitors. At the time of our inspection there were 28 people living at the home.

There was a registered manager in post at the time of our 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.’

We last inspected the home on in July 2014, when we found the service to be compliant with all the regulations we assessed at that time.

People who used the service, visiting relatives and friends told us they or their loved ones were supported by staff that were kind, friendly and caring, which made them feel safe.

We found people were protected against the risks of abuse, because the home had appropriate recruitment procedures in place. We saw appropriate checks were carried out before staff began work at the home to ensure they were fit to work with vulnerable adults.

We saw safeguarding and whistleblowing telephone contact numbers were displayed in the reception area for the use of people who used the service, their relatives and staff. This information was also available in the ‘service user guide.’

We found people were protected against the risks associated with medicines, because the provider had appropriate arrangements in place to manage medicines safely.

As part of the inspection, we looked at how the service ensured there were sufficient numbers of staff on duty to meet people’s needs and keep them safe. We found there were sufficient numbers of staff on during our inspection to support people who used the service.

The registered manager told us all new staff undertook an induction programme, which included obtaining the care certificate over a 12 week period. Depending on previous experience, all new staff underwent a probationary period of three to six months.

All staff we spoke with confirmed they received regular supervision and appraisals, which we verified by looking at supervision records. Supervisions and appraisals enabled managers to assess the development needs of their staff and to address training and personal needs in a timely manner.

The home managed Deprivation of Liberty Safeguards ( DoLS) applications on a comprehensive spread-sheet. Staff we spoke with were able to explain the basic principles of DoLS and knew how to seek advice from the manager if they had any concerns about an individual’s capacity or rights. We were able to verify from training records that staff had received training in the Mental Capacity Act.

People we spoke with were very complementary about the food they received, the skills of the cook and confirmed they received a choice.

The interactions between staff and people who used the service was observed to be caring and respectful at all times. People were given time to communicate their wishes. Privacy and dignity of people who used the service was maintained at all times and the general atmosphere within the home was calm.

Staff we spoke with demonstrated a good knowledge of person-centred care principles and the importance of respecting peoples’ rights and preferences. Throughout our inspection we observed that staff treated people with dignity and respected their privacy.

The home was part of the Six Steps End of Life Care programme delivered by Salford Royal NHS Foundation. This programme is intended to enable people to have a comfortable, dignified and pain free death.

The registered manager advised that there was a scheduled programme of in house activities for people who used the service. During our inspection we observed an absence of any stimulation for people other than watching television.

As part of this inspection we ‘case tracked’ five people who used the service. Care plans showed evidence of personalisation and regular reviews. However, there was limited information available regarding levels of independence and enablement i.e. what the resident could do for themselves.

We found the service routinely and actively listened to people to address any concerns or complaints.

People told us they believed the registered manager was doing a good job managing staff and services within the home.

Staff told us they believed there was an open and transparent atmosphere in the home, they felt supported in their role and that the registered manager was very approachable.

We found the service undertook a comprehensive range of audits and checks to monitor the quality of services provided. These included regular fire systems checks, environmental audits, monthly medications audits, accident reports, care plans, falls audit including action taken, training requirements and a night check audit.

The home had policies and procedures in place, which covered all aspects of the service. The policies and procedures included; safeguarding, whistleblowing, mental capacity act, consent, medication and supervision.

As part of the inspection we spoke to seven people who used the service, four visiting relatives and two health care professionals. We also spoke to seven members of staff.

At the time of our inspection, the manager had been in place since April 2014 and had recently submitted an application to CQC to formally register as manager. We were informed that a number of changes had taken place and that the service was still undergoing a programme of change and improvement.

Our inspection was co-ordinated and carried out by an inspector, who addressed our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

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

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

Is the service safe?

We found people were treated with respect and dignity by the staff. People told us they felt safe. One person who used the service told us; 'Yes I feel safe here, the staff are great.'

Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Staff we spoke to were able to demonstrate a good understanding of the legislation and its requirements.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly therefore people were not put at unnecessary risk.

The manager set staff rotas having regard to people's care needs, qualifications, skills and experience of staff required. People told us they felt staffing levels were adequate. This helped to ensure that people's needs were always met.

Recruitment practice was safe and thorough.

Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

Is the service effective?

Though people told us they felt they had been involved in determining their care needs, it was not always clear to us from looking at care files that people had been consulted.

Specialist dietary, mobility and equipment needs had been identified in care plans where required.

People's needs were taken into account with signage and the layout of the service enabling people to move around freely and safely.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. People commented, 'No concerns, visitors just pop in.' 'I think it is a good place, they do take care of people here.' 'I go to bed when I want to, or chill out in my room.' 'I'm content as you can be in a place like this.' A relative told us; 'X seems content here and doesn't want to move.'

People who used the service and their relatives completed a satisfaction survey. Where shortfalls or concerns were raised these were addressed.

We found care and support had been provided in accordance with people's wishes.

Is the service responsive?

People completed a range of activities in and outside the service.

People knew how to make a complaint if they were unhappy. We looked at how these complaints had been dealt with and found that the responses had been open, thorough, and timely. People could therefore be assured that complaints were investigated and action taken as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. One visiting health care professional told us; 'Things have improved from what I can tell. No concerns around safety.'

The service had quality assurance systems, records viewed by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities.

Since the last inspection on 3 September 2013 an additional member of staff; working a three hour shift; had been provided to cover over the lunchtime period.

We looked at staff training records and saw staff had completed mandatory and specialist training to ensure that they knew how to meet the needs of each person.

Due to the nature of their conditions not everyone who used the service was able to speak with us. People we spoke with and their relatives were happy with the care provided. Comments included, 'I'm satisfied with the staff, I think they are good' and 'I always feel safe here, the care is good' and 'I think the care is fantastic. I sometimes pop in at any time and I am always satisfied with my relatives care'.

We found people were protected from unsafe or unsuitable equipment as regular servicing and maintenance checks were in place.

During our inspection we observed there were not always enough qualified, skilled and experienced staff to meet people's needs. We had some concerns that people's needs and preferences were not always being met.

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

During our visit we saw care staff communicating positively with people who used services. People who required support with their personal care needs were treated with respect and dignity. Where people's communication abilities were limited, we saw that nurses and care staff had a good understanding of people's body language and responded appropriately.

Staff told us that they received supervision but, when asked, were unsure of how often this took place. Records seen indicated that supervision was being carried out. The registered manager acknowledged that improvements were needed to ensure staff supervision and appraisals took place regularly and told us she had plans to "crack on with the supervisions and appraisals."

From speaking with the manager and staff it was clear that they had a good knowledge and understanding of people's needs and how best to meet those needs. We saw staff supporting and assisting people at a pace that was unhurried and met their needs.

The provider had systems in place for regular monitoring of the service.