Archived: Cherry Trees Care Home

We considered all the evidence against the outcomes we inspected to help answer our five key questions; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service told us, 'I like to have a walk to the shops or the pub, they like me to be back by dark but I have a mobile phone that they can ring if they are worried about me" and 'I can have a bath more or less when I want.'

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

We found risk assessments had been undertaken to identify any potential risk and the actions required to manage the risk. This meant that people were not put at unnecessary risk but also had access to choice and remained in control of decisions about their lives.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. One application had been submitted which confirmed to us that relevant staff had been trained to understand when an application should be made and how to submit one. This meant that people would be safeguarded.

We found the home to be clean with effective implementation in place to help prevent cross infection.

Is the service effective?

We found people were provided with nutritious food. Some people required specialised diets for health or personal reasons and these were provided.

People who used the service told us, 'They know what I like and what I don't. I don't like batter on fish and they never give me it' and 'They [staff] come round with a list of food and we can choose what we want. I choose but I don't always remember."

During our visit, we found people were provided with the support they needed. We found staff knew people well and were aware of their individual preferences. We found staff treated people in a kind manner.

Care files we checked confirmed that initial assessments had been carried out by the staff at the home before people moved into the home. This was to ensure the home was able to effectively meet the needs of the people. Specialist mobility and equipment needs had been identified in care plans where required. People and their relatives said they had been involved in writing them and they reflected their current needs. Visitors confirmed they were able to see people in private and that visiting times were flexible.

Staff were provided with training to ensure they had the skills to meet people's needs. We looked at staff supervision forms and found a significant number of staff had not received formal supervision during 2014. Also all staff had not been provided with a yearly appraisal. This meant staff were not properly supervised and appraised.

We have asked the provider to tell us what they are going to do to ensure persons employed are receiving appropriate supervision and appraisal.

Is the service caring?

People who used the service were positive about the staff and felt they were known personally to them. People told us, 'I was supposed to go back home but I liked it and wanted to stay here' and 'It's not a bad place. None of us want to be in a home but it's not bad.'

Relatives told us, 'The staff are usually very good as far as I can tell. One or two'well we can all have a bad day, can't we?' and 'Another relative of ours is also in a care home and this compares very well with that one.'

During lunch we observed there were missed opportunities to engage with people who used the service. On two occasions a member of staff walked away before the conversation started with a person who used the service was concluded.

We found staff skills in recognising and respecting the diversity and human rights of people who used the service varied significantly. Some staff were able to tell us how important it was for people, other staff were less understanding of the concepts of privacy, dignity and independence. For example at lunchtime the staff were serving white bread with the soup when a person asked if their sandwich could be in white bread they were told, 'No it's brown bread on the sandwiches.'

Is the service responsive?

Staff and a relative told us the care and support provided was flexible to the person's needs and adjustments could be made where required. Staff said they informed the manager if they felt any change in needs was required and the support was reviewed. For example one person who lacked dexterity after a stroke told us, 'Someone will come and sit with me if I want to write a letter or a birthday card. They will write it for me.'

A relative told us about the positive experience their family had when moving [family member] into the home. They told us, 'We could bring furniture and even bang nails into the walls to hang pictures, so we could make the room as personal as possible before [family member] moved in.'

On the day of the inspection the activities co-ordinator was observed working hard to engage residents with activities after lunch, with positive results.

People who used the service said if they had any worries they would take their concerns to a member of staff. One relative asked us what they could do if they had a concern that they did not want to raise with the home management. We provided them with contact details for CQC and suggested they would able to make a call to the inspector if they wished. They said they did not have any concerns that needed discussion at present.

Is the service well-led?

We found sufficient staff were on duty, however they were not often observed focusing on people who used the service in a sustained or meaningful manner. The call for people to participate in activities was the most noticeable exception to this. People who used the service did not complain about the staff but were not seen engaging with them in conversation, other than whilst staff were providing support or care to them.

The service worked well with other agencies and services to make sure people received their care in a joined up way.

People spoken with said they were invited to attend 'resident and relative meetings'. One person said, 'It's a good idea, we can talk about whatever we want."

Staff had regular meetings with the manager and were kept updated about any information they needed to know about the service. This helped to maintain consistency in the running of the service and to ensure staff were aware of relevant information.

The service carried out a yearly 'Quality Assurance Survey'. Feedback was sought by way of customer satisfaction surveys sent to people who used the service, their relatives and friends, staff and healthcare professionals. This showed people had the opportunity to put their views across.

The service had a quality assurance system. Monthly and weekly audits were completed regarding such things as medication, care plans, the environment and infection control. This meant intervention and improvements were made within a reasonable timescale.

At this inspection we found that people were asked for their consent to care and treatment and the staff acted in accordance with their wishes. One person told us, "The staff always listen to me and do as I ask."

Care records showed they had been audited by the home manager and the regional manager. Care plans had been reviewed and updated so that there was a full and accurate record of the care and support provided to people.

People that we were able to communicate with told us that they were happy living at the home. Their comments included, "It's ok here," "I'm very happy here" and "They [staff] make me as comfortable as possible."

We found people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained. We found that records were held securely and retained for an appropriate period of time.

During our SOFI observation we found that staff had positive interactions with people and staff spoke patiently and kindly with people.

We spoke with eight people who used the service. People that we were able to communicate with told us that overall they were happy living at the home. Their comments included, "I like it here, the staff are kind and generous," "I'm much better off here than I was at home" and "It's just perfect."

We spoke with five relatives. One relative told us, "Our family members levels of care appear ok and she is reasonably happy considering her condition. If there are any problems, staff contact us."

We found that each person had a care plan which explained that consideration needed to be given to capacity and deprivation of liberty legislation to ensure people's rights were protected. There was no evidence to demonstrate that this had been followed when it was indicated that a person lacked capacity.

Our conversations with people, relatives and staff, evidenced that there were enough staff on duty to meet people's needs.

The provider had an appropriate system in place for gathering and evaluating information about the quality of care the service provided.

People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.

Records checked showed that before people received any care or treatment they were asked for their consent and the staff acted in accordance with their wishes. Relatives we talked with told us, where people lacked capacity, they were involved in decision making.

We spoke with four relatives who were visiting the home and they confirmed that they were satisfied with the care provided.

We spoke with a visiting healthcare professional. They said, "when we are here treating people, we are thoroughly supported and appreciated by the staff."

We found that, where necessary, people were supported with the administration of their medicines, by staff that were trained in medication administration.

We found that a complaints policy and procedure was in place. All of the people and their relatives spoken with said they had no complaints or concerns about the home.

We spoke with Barnsley Local Authority, Contracting and Commissioning and they told us that they had not identified any concerns at the home.