Archived: Cherrytrees

Cherrytrees is a residential care service for six people who have a learning disability. People who live at Cherrytrees may also be living with other physical and mental health conditions. The service is run by Somerset Council (Learning disability services).

A registered manager was based at the service. 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.

Prior to 2013 Cherrytrees had provided a respite care service for people who lived at home with their family. In 2013 the service changed to a full time residential facility and people who had been using it for respite moved in on a full time basis. The registered manager and staff supported people and their families with this transition, which for some had involved big changes in their care and lifestyle. The registered manager and staff said they have continued to work closely with families to support them and people in the service as their needs, lifestyle and opportunities changed and developed. We were told further changes were planned in the service, which would have some impact on the way care and accommodation was provided to people. We saw this stage was at a transition phase and people, staff and relatives had been kept well informed and involved in the process. The registered manager felt changes to the service would have a positive impact on people and would give them greater choice and control over their care and lifestyle. It was too early for us to see the impact these changes would have on people, however they would be considered as part of on-going inspections of the service.

Staff knew people well and were able to tell us in detail about their needs and how they were supported. However, people’s care plans did not in all cases provide a sufficient level of detail about people’s needs or about how they chose and preferred to be supported. The absence of this written information could mean people’s needs might not be met consistently or in a way they wanted and preferred.

We saw people partaking in different activities inside and outside the home and staff told us about people’s interests and different ways people liked to occupy their time. However, the home’s recording systems did not always include sufficient detail about how people had spent their time or if activities had been enjoyed. Systems were in place for staff to record daily how people had spent their time and how they had been supported. However, we saw this recording was in many cases very brief and did not provide a clear and accurate summary of the person’s day. The absence of good quality, meaningful records could mean the service would be unable to have an overview of how people’s needs were being met.

There was a positive culture in the service. Staff spoke about people’s achievements and encouraged people to develop their skills and be as independent as possible. Throughout the inspection we saw staff smiling and looking happy as they supported people, comments from staff included, “It is a good place to work, people are happy and have a good life”.

We saw staff were respectful and cared about the people they supported. Staff knew people well and were able to respond promptly if they showed signs of being uncomfortable or anxious. One person became anxious when someone they didn’t know visited the home. The staff were very aware of this and provided them with gentle words of reassurance throughout our visit.

Relatives and other agencies were positive about the service. Comments from relatives included, “I can only speak highly of the staff. They have been like an extended family, I have been on my own so it has been so important to have their support and know I can trust [….] is being well cared for”, and “ Nothing is too much trouble for them, I went into hospital and I didn’t have to worry”. Other agencies said they had been impressed with how organised management and staff had been when planning a hospital admission. They said the staff knew the person very well and helped other professionals understand what the person could find difficult and how to support them.

There were sufficient numbers of skilled staff to support people and to keep them safe. Staffing levels were regularly reviewed and planned in line with people’s daily routines to help ensure they were able to do what they needed and wanted. The provider had clear and effective recruitment procedures in place and carried out checks when they employed staff to help ensure people were safe. People were protected by staff who knew how to recognise signs of possible abuse. Staff said they believed reported signs of abuse or poor practice would be taken seriously and investigated thoroughly. Relatives said they trusted and felt confident people were safe and well cared for.

Staff were well trained and said training was relevant to their role and was kept updated. The organisation offered all staff the opportunity to undertake training specific to the needs of people they supported. For example, one person had very specific needs in relation to living with diabetes. Staff had attended diabetic training, blood glucose monitoring training, and also had specific advice and guidance from the diabetic nurse involved in the person’s care. Another person had also been diagnosed with early stage dementia and was being assessed as part of the health authorities Dementia Pathway. Staff had attended dementia training and plans were in place for dementia champions from within the organisation to visit the home and advise staff of best practice and care for this person. Dementia Champions are staff specifically trained in areas of best practice to support people living with Dementia.

Staff said they felt well supported by management and their colleagues. Staff meetings, supervision and handover meetings provided staff with opportunities to share ideas, reflect on practice and keep updated about important information.

Staff asked for people’s consent as they provided care. They were able to describe how they supported people to make decisions and choices and were involved in completing capacity assessments. Staff had undertaken training on the Mental Capacity Act (MCA) 2005. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people were assessed as not having the capacity to make a decision, a best interest decision was made, involving people who knew the person well and other professionals, when relevant.

People had their medicines managed safely. Staff undertook training and understood the importance of the safe administration of medicines. People were supported to maintain good health and when required had access to a range of healthcare services. People were involved in decisions about what they would like to eat and drink. Staff understood any risks associated with eating and guidelines were in place in relation to choking hazards and special dietary needs.

The building had been purpose built, and provided sufficient space and level access for people using the service. Recent refurbishments within the service had taken into consideration feedback from relatives as well as people’s current and changing needs. For example, relatives had said the communal areas sometimes felt institutionalised. The hallway, kitchen and dining area had been re-decorated with colours, pictures and personal items added to give a more homely and personalised feel. The kitchen area and laundry had been refurbished to increase space and to add appliances suitable for people with physical and mobility needs.

The registered manager used effective systems to monitor the quality of the service, and had on-going plans for improving the service people received. Learning from quality audits, incidents, concerns and complaints were used to help drive continuous improvement across the service.

We found that staff consulted with people in order to gain their consent. When consent was required that related to complex decisions, we found that advocates had been involved so that people's best interests were taken into account.

We found that people's health and welfare needs were being met and that support given was individualised and person centred.

Evidence informed us that systems were in place to protect people from possible abuse and that staff had an awareness of safeguarding issues.

We found that the home was clean, safe, well maintained and suitable to the needs of the people living there.

We found that staff were available in sufficient numbers and were experienced and knowledgeable; ensuring that they were able to meet the needs of people living in the home.

We found the quality of the service was being monitored and that systems were in place to meet people's health, welfare and safety needs.

We saw staff involved people when they were preparing meals. We observed staff supporting people to eat at a pace that was safe for their swallowing abilities. One example of staff ensuring people were part of the community was having sweets available for members of the public who may have visited the home for 'treat or trick.'

The staff we talked with knew the preferences of people they cared for. We saw when people exhibited certain behaviours the staff knew people were making choices about where they wanted to sit. Staff said they knew when people were unhappy

People went shopping and to local cafes with staff, but there were limited opportunities to experience a variety of community activities. The manager told us activities in the community were to be arranged in the future.