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Cherry Tree House Requires improvement

We are carrying out a review of quality at Cherry Tree House. We will publish a report when our review is complete. Find out more about our inspection reports.


Inspection carried out on 19 September 2019

During a routine inspection

About the service

Cherry Tree House is a care home located in a purpose-built detached property. Communal areas include spacious living and dining areas, kitchens and secure gardens. The property is on two floors with access by lift and stairs. Two self-contained bungalows are within the secure garden.

The service can provide support and accommodation for up to 11 people who have learning disabilities, autistic spectrum conditions or additional needs. At the time of our inspection, eight people were living there.

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

Risks to people’s safety had not always been assessed or reviewed as required. This could place people or staff at risk of harm.

Systems for monitoring, reviewing and improving quality and standards were not always effective. Some checks were not in place, and others did not identify shortfalls or highlight action when required.

The provider had not displayed the latest CQC inspection rating on their website. This meant people did not have easy access to information about the service.

Some care plan reviews had not taken place as scheduled. Care plans were personalised and helped identify what was important to people.

There had been improvements at the service since the last inspection. We received positive feedback about the new manager, and changes had been made to improve the culture and the quality of care provided.

People's medicines were administered and managed safely. Staff received training and the provider regularly checked staff’s competency in the management of medicines.

Staff felt supported and received training and appraisals. Some staff had not had supervision as frequently as the provider required, but a plan was in place to address this. People were supported by enough staff and regular agency staff were used when needed. Staff were safely recruited.

We received positive feedback overall from relatives. They said their loved ones generally seemed happy living at Cherry Tree House. Staff were kind and caring and treated people with dignity and respect.

People were supported to maintain social relationships and participate in some activities. A plan was in place to develop activities further.

Staff had contact with other professionals to ensure people’s needs could be met. People accessed routine and specialist healthcare services and were supported to eat and drink enough to remain healthy.

People were supported to have some choice and control in 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.

The service applied the principles and values of Registering the Right Support and other best practice guidance where possible. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The service was registered for the support of up to 11 people and was not a domestic property. This is not in line with current best practice guidance. However, the building was well established in the residential area, and steps had been taken to ensure it fitted in to the local community. Staff did not wear anything that suggested they were care staff when coming and going with people.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support was now focusing on them having opportunities for them to gain new skills and become more independent, although this was a change which had only been in place for a few months.

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 a

Inspection carried out on 30 October 2018

During a routine inspection

Cherry Tree House provides accommodation and personal care for up to 11 people. At the time of our visit there were 10 people living at the service. The service had one room reserved for a person however the transition was on hold.

At the previous inspection carried out on 17 September 2016 we rated the service as good and did not identify any breaches in regulation. At our inspection on 30 and 31 October 2018 we found that the registered provider was in breach of multiple regulations 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.

There was not a registered manager in post. A new manager had started and was in the process of completing their induction. They planned to apply to CQC to be the registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

Why we have rated this service as Requires Improvement?

Medicines were not managed safely. We identified discrepancies and recording errors with the medicines system.

Risks had not always been assessed and the appropriate action was not always taken to minimise the risk of harm to people and staff.

Staff were not being supported within their role. Staff did not receive supervision and guidance within their role.

When restraint had been used debriefs were not carried out by staff. Documented debrief information, and detailed clear recording and support are used to learn from the incident and to ensure that restraint has been used legally, appropriately and safely.

The home was not always caring which had affected the wellbeing of people. They did not receive continuity of care which was important to their needs. There was a lack of respect and regard of the person’s needs.

There was a lack of effective leadership in the home and the staff did not feel supported. The provider did not have insight into what was going on in the home and this led to multiple breaches of regulations.

Quality assurance systems were not effective to assess and monitor the quality of service people received and identify any areas that required improvement.

People were protected from the risk of infection. Staff understood the importance of infection control and prevention.

We received mixed feedback about staffing levels at the home. Appropriate checks were made before staff started to work to make sure they were suitable to work in a care setting.

Staff received training to develop the skills needed to care for people effectively. People told us they enjoyed the meals and we saw staff offered people hot and cold drinks throughout the day.

People's care was provided in line with the Mental Capacity Act and staff understood the importance of seeking appropriate consent for care and treatment.

People were encouraged to attend appointments with other health care professionals to maintain their health and well-being.

Inspection carried out on 7 September 2016

During a routine inspection

The inspection took place on 7 September 2016. This was an unannounced inspection. The service was last inspected in May 2014. There were no breaches of regulation.

The service is registered to provide accommodation for up to 11 people and cares for people who predominantly have learning disabilities needs. At the time of this inspection, there were nine people using the service.

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.

The service was safe. Risk assessments were implemented and reflected the current level of risk to people. There were sufficient staffing levels to ensure safe care and treatment. The administration, recording and storage of medication was safe. The registered manager took appropriate steps to ensure suitable people were employed to support the people using the service.

People were receiving effective care and support. Staff received appropriate training which was relevant to their role. Staff received regular supervisions and appraisals. The service was adhering to the principles of the Mental Capacity Act 2005 (MCA) and where required the Deprivation of Liberty Safeguards (DoLS).

The service was caring. People and their relatives spoke positively about the staff at the home. Staff demonstrated a good understanding of respect and dignity and were observed providing care which promoted this.

The service was responsive. Care plans were person centred and provided sufficient detail to provide safe, high quality care to people. Care plans were reviewed and people were involved in the planning of their care. There was a robust complaints procedure in place and where complaints had been made, there was evidence these had been dealt with appropriately.

The service was well-led. Quality assurance checks and audits were occurring regularly and identified actions required to improve the service. Staff, people and their relatives spoke positively about the registered manager.

Inspection carried out on 14 May 2014

During a routine inspection

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found which describes what we observed, what the staff told us, and the records we looked at.

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

Is the service safe?

There were enough staff on duty to meet the needs of the people who used the service and they had all received relevant training in order to carry out their roles. We saw that staff ensured people's personal safety was maintained whilst parts of the building were being refurbished by ensuring some areas were not accessible to people. We also saw that these areas were only out of bounds for limited periods of time and as soon as it was safe to do so, people were able to access the whole building again. We saw that people's care plans detailed where their safety might be at risk, and what staff should do to prevent this.

Is the service effective?

Due to communication difficulties and because some people were out for part of our inspection, we were unable to speak directly with people who used the service. However, the people we saw and met, appeared smart, comfortable and calm and were interacting well with the staff. The atmosphere was friendly and calm and people appeared well cared for. Staff we spoke with confirmed that they had received service specific training such as positive behaviour management to help them in their role.

Is the service caring?

We spoke with four members of staff; one support worker, one senior support worker, one team leader and the registered responsible person. The staff told us "I love my job, helping people with supported living and making a difference to people's lives" and another told us "it's a lovely home, with lovely people" and "I really love working with people with learning difficulties". We observed staff talking and sitting with people. We also saw that people were encouraged with activities.

Is the service responsive?

Records contained people's individual preferences and personal care needs and behaviour assessments and people were supported to access activities. We were told that one person who used the service enjoyed cooking and so they were assisted and encouraged to make some of their own meals with staff help.

Is the service well led?

There was no registered manager available at the time of our inspection. We were told that a new manager had been appointed, but we had not received an application at the time of the inspection.