Archived: Cherry Tree Care Centre

When we completed our previous inspection in February 2016 the service was rated good. At this inspection we found the service was no longer meeting all the required standards to retain this rating.

This is the first time the service has been rated requires improvement.

Cherry Tree Care Centre 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 service can accommodate a maximum of 42 people across two floors, each of which have separate adapted facilities. The first floor specialises in providing care to people living with dementia. At the time of this inspection there were 38 people using the service.

The previous registered manager of the service formally de-registered with CQC in January 2017. There had been no registered manager in place since that time. This has been dealt with outside of the inspection process. A new manager has now been appointed and begun the registration process. 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.

The systems in place for medicines management did not keep people safe.

When we arrived at the service on the first day of inspection the rear of the property was not secure. This meant people could leave the building when it was not safe for them to do so and also left people vulnerable to the risk of intruders. There were a number of environmental hazards around the service. Unattended kettles, bottles of alcohol and cleaning items were all easily accessible.

Accidents and incidents were recorded but there was no evidence that lessons had been learned as a result of this monitoring. The service did not always accurately monitor risks to people or ensure staff had the information necessary to minimise those risks.

There was currently no system in place to determine the number of staff or skill mix required to safely meet people’s needs. There was evidence of safe recruitment practices. Appropriate checks had been done before staff started work to reduce the risk of unsuitable people being employed. Where agency staff were used inductions were not always carried out.

Staff had received safeguarding training and they were able to explain what they would do if they had any concerns.

Maintenance and health and safety checks of equipment were regularly conducted. Records showed that when an issue was identified this was quickly rectified. Tests of fire equipment was undertaken but there had not been a recent evacuation drill.

There was a training matrix for mandatory training but the manager had no oversight of what additional training staff had undertaken. Specialist training had not been delivered to cover all aspects of people’s care needs, for example in behaviours that challenge or stoma care.

Staff did not always have time to read people’s care plans and therefore did not always have access to up to date information about their needs.

Staff had not all had regular supervision in line with the provider’s policy. Some staff had not had a supervision meeting since January 2018.

Kitchen staff had a good knowledge of people's dietary requirements and were able to tell us the adjustments they would make to support people’s diets. Mealtimes were calm and relaxed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. However, some best interest decisions did not clearly indicate who had been involved in the decision-making process.

People were supported to maintain their health and wellbeing. People's care records contained evidence of visits and advice from a variety of health professionals.

The use of dementia friendly signage was not consistent throughout the building.

Prior to admission a full assessment of people’s care needs was undertaken. This was a comprehensive document that looked at all aspects of people’s needs including any religious beliefs or cultural requirements

People who used the service and their relatives were very happy with the care their loved ones received. Staff treated people with dignity and respect and promoted independence.

People told us they felt staff did treat them as individuals. However, care plans were not written in a personalised way, instead they listed the general tasks necessary to provide basic support to the person. Activities were not tailored to meet people’s personal preferences.

There was a complaints procedure in place and people were aware of how to make a complaint if necessary.

Care plans were not up to date or accurate. Audits were not picking up on the issues we found and there was no evidence that feedback was being used to improve standards at the service.

During this inspection we found three 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 the report.

The inspection took place on 4 February 2016 and 8 February 2016. The first day of the inspection was unannounced which meant that the staff and registered provider did not know that we would be visiting. We informed the registered provider of our visit on 8 February 2016.

Cherry Tree Care Centre is a purpose built care home providing accommodation over two floors. There is a garden area to the exterior of the property and onsite parking facilities. The service is located close to local amenities including shops and cafes.

The service is registered to provide residential care and support for up to 42 people. At the time of our visit there were 38 people using the service. The Jasmine Suite provides residential care on the ground floor and the Sunflower Suite on the first floor provides care for people living with dementia. The two floors are accessed by both stairs and a passenger lift.

The home had a registered manager in place. 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.

When we last inspected the service we found that the provider was failing to comply with Regulation 18 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 (the Regulated Activities Regulations 2010), consent to care and treatment. Decisions were being made that limited people's rights without the appropriate assessment of capacity and no DoLS applications had been made in respect of those individuals who were at risk of being deprived of their liberty.

At this inspection we found that improvements had been made in this area. Care records contained appropriate assessments and staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions.

From our observations it was clear that staff knew the people who lived at the service well and we saw that they responded to their care needs accordingly.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of the action they should take if they suspected abuse was taking place. Staff were aware of whistle blowing procedures and all said they felt confident to report any concerns without fear of recrimination.

We looked at care plans and found that they were written in a person centred way but were sometimes lacking detail. The care records we viewed showed us that people had appropriate access to health care professionals such as dentists and opticians. We saw that individual risk assessments were not in place in place to cover all of the key risks specific to the person however we saw evidence that this was being addressed during our visit.

We observed that people were encouraged to be independent and to participate in activities that were meaningful to them. We saw people enjoying a film on television in the afternoon and a singer also visited to entertain people during our visit. We were also told that in good weather people enjoyed spending time in the garden. Some people had expressed the desire for a pet during a residents' meeting and there was now a fish tank and a pet rabbit in the home.

There were sufficient numbers of staff on duty to meet the needs of people who used the service. Safe recruitment and selection procedures were in place and appropriate checks had been undertaken prior to staff starting work. The checks included obtaining references from previous employers to ensure that staff were safe to work with vulnerable people.

Staff received appropriate training and demonstrated that they had the skills and knowledge to provide support to the people they cared for. Staff also received regular supervisions and annual appraisals.

Appropriate systems were in place for the management of medicines so that people received their medicines safely.

We saw that people were provided with a choice of healthy food and drinks to help ensure their nutritional needs were met. Staff demonstrated knowledge of people’s likes, dislikes and special dietary requirements. Food was fortified with butter and cream for those people who needed extra sustenance and alternative dishes prepared for those people who needed to monitor their intake of sugar or gluten.

The service had a complaints procedure in place and this was clearly displayed within the home.

There were systems in place for monitoring and assessing the service. Action plans were produced to address any issues identified during the quality assurance process and any necessary changes were implemented.

We saw safety checks and certificates that were all within the last twelve months for items that had been serviced and checked such as fire equipment and electrical safety.

We spoke with staff who told us they felt supported and that the registered manager was always available and approachable. Throughout our visit we saw that people who used the service and staff were comfortable and relaxed with the registered manager and each other. Staff were observed to be caring and respected people’s privacy and dignity. There was a relaxed atmosphere and we saw staff interacted with each other and people who used the service in a very friendly and respectful manner.

Our inspector carried out this responsive inspection to follow up on concerns identified at our previous inspection in October 2013. We gathered evidence against these particular outcomes which enabled us to answer three of our five key questions; Is the service safe? Is the service effective? and Is the service well led?

We looked at a six sets of care records, spoke with the regional director, registered manager and deputy manager. Throughout the inspection visit we also spoke with four care staff of varying roles and we spoke with four people who used the service.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the manager and staff.

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

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that no one who used the service was subject to any DoLS. We did note that the home had been directed, by a visiting professional, of the need to apply for DoLS for a number of people who used the service. At the time of our inspection no applications in respect of these individuals or their circumstances had been made.

Is the service effective?

We found that where people lacked the capacity to consent the home did not act in accordance with legal requirements.

We found that best interest decisions were made on behalf of people who used the service despite formal capacity assessments, as required by the Mental Capacity Act 2005, not being completed. We found that because some people lived with a dementia there was an assumption that they were unable to make certain decisions or give consent in certain aspects.

Staff had not received appropriate training to equip them with the necessary understanding of the Mental Capacity Act 2005 and its legal requirements.

Is the service well led?

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

We found that the home completed a range of audits on a monthly basis, that led to the identification of areas of improvement throughout the service. We saw that at a provider level significant improvements had been made to ensure that internal monitoring of the service was effective and that the home was able to identify, learn from and improve areas of service provision.

We saw evidence that the safety of people who used the service was proactively considered. We found that the home had systems in place to ensure accidents and incidents were identified, analysed and where necessary action taken to prevent or minimise the risk of recurrence.

What people told us:

We spoke with four people who used the service. People told us that they were happy and content living at the home.

People told us that they felt safe when care and support was being delivered to them.

Comments that these people made included, "I am quite happy here" and "I like it they (the girls) look after me".

Some of the people who lived at the home had marked problems with their memory and found it difficult to think about recent events or at times, to have a conversation. So we could understand the experiences these people had of care and support, we carried out a structured observation during our inspection called a Short Observational Framework for Inspection (SOFI).

We found that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People's health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services because the provider worked in co-operation with others.

Where people did not have the capacity to consent, the provider had failed to develop systems to ensure that they acted in accordance with legal requirements.

People who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

The provider did not have an effective system to regularly assess and monitor the quality of service that people receive.

The people we spoke with told us that they were very pleased with the service and felt the staff were excellent at their jobs. People said that they felt able to raise any of concerns with staff and were confident that any issue would be resolved. People told us; 'Staff are absolutely fantastic, I couldn't think they could improve at all', 'We are like one big family', and 'I have no complaints at all, as the staff are superb'.

The relatives told us that they felt confident that the manager and staff would make sure the service met people's needs. Relatives told us; 'The care is wonderful and the staff always go the extra mile', 'Staff really care about my relative and us, as well, which I find is such comfort', and 'The manager always makes sure the home is well run'.

From our observations and discussions with people we found that care staff worked in ways that supported the people who used the service and treated individuals with humanity as well as empathy.

We found that some areas of the home needed refurbishment and although plans were being made to do this we could not find out when this would happen.