Cherry Tree Lodge Nursing Home

Cherry Tree Lodge accommodates 19 younger adults who have a learning disability in one adapted building. There were 17 people living in the service at the time of our inspection. Most of them had special communication needs and expressed themselves using single words, vocal tones and sign assisted language. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service was run by a company who was the registered provider. 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. In this report when we speak about both the company and the registered manager we refer to them as being, ‘the registered persons’.

At our last inspection on 18 February 2015 the service was rated, ‘Good’. However, we found that improvements were needed to ensure that people were fully supported to express their individuality by pursing their hobbies and interests. As a result of this shortfall we rated our domain ‘responsive’ as, ‘Requires Improvement’.

At the present inspection we found that sufficient progress had been made to address the concerns we previously raised in relation to the provision of responsive care. In addition, our overall rating for the service remained as, ’Good’.

There were systems, processes and practices to safeguard people from situations in which they may experience abuse including financial mistreatment. Most risks to people’s safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. In addition, medicines were managed safely. Suitable arrangements had been made to ensure that sufficient numbers of suitable staff were deployed in the service and background checks had been completed before new nurses and care staff had been appointed. People had benefited from most of the necessary steps being taken to prevent and control infection and lessons had been learnt when things had gone wrong.

Nurses and care staff had been supported to deliver care in line with current best practice guidance. This included supporting people when they became distressed. People received most of the individual assistance they needed to enjoy their meals and they were helped to eat and drink enough to maintain a balanced diet. In addition, suitable steps had been taken to ensure that people received coordinated and person-centred care when they used or moved between different services.

People had been supported to live healthier lives by having suitable access to healthcare services so that they received on-going healthcare support. Most areas of the accommodation were adapted, designed and decorated in a way that met people’s needs and expectations.

Suitable arrangements had been made to obtain consent to care and treatment in line with legislation and guidance.

People were treated with kindness, respect and compassion and they were given emotional support when needed. They had also been supported to express their views and be actively involved in making decisions about their care as far as possible. This included them having access to lay advocates if necessary. Confidential information was kept private.

People received personalised care that was responsive to their needs. As part of this people had been offered opportunities to pursue most of their hobbies and interests. People’s concerns and complaints were listened and responded to in order to improve the quality of care. In addition, suitable provision had been made to support people at the end of their life to have a comfortable, dignified and pain-free death.

There was a positive culture in the service that was open, inclusive and focused upon achieving good outcomes for people. People benefited from there being a robust management framework that helped nurses and care staff to understand their responsibilities so that risks and regulatory requirements were met. In addition, the registered persons had taken various steps to ensure the financial sustainability of the service.

The views of people who lived in the service, relatives and staff had been gathered and acted on to shape any improvements that were made. Quality checks had been completed to ensure people benefited from the service being able to quickly put most problems right and to innovate so that people could consistently receive safe care.

Good team work was promoted and staff were supported to speak out if they had any concerns about people not being treated in the right way. In addition, the registered persons were actively working in partnership with other agencies to support the development of joined-up care.

People who used the service had special communication needs. They used a combination of short sentences, words, signs and sounds to express themselves.

We considered our inspection's findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This is a summary of what we found:

Is the service caring?

People said that staff were respectful, kind and attentive. They considered staff to be kind and to be genuinely committed to helping them. Relatives were confident that staff were polite and courteous to people who used the service.

Is the service responsive?

We saw that people's individual needs for nursing and personal care had been assessed and met. Staff knew about each person's care needs, choices and preferred routines. People said that their care needs were met in a flexible way with staff being happy to adjust the assistance they provided according to the person's changing needs and wishes.

However, we found that some people were not being fully supported to participate in occupational and social activities.

We have told the provider that it must make improvements to ensure that the service is responsive. This is necessary so that all people who use the service are offered sufficient opportunities to participate in occupational and social activities.

Is the service safe?

People were helped to stay safe by avoiding most risks to their health and safety. There were safe working practices to help people with reduced mobility. This reduced the likelihood of people experiencing falls and accidents.

We saw that there were reliable arrangements for ordering, storing and administering people's medication. This meant that people were assisted to use prescribed medicines safely.

However, there were shortfalls in the arrangements used by the provider to manage people's finances. There was no evidence to show that people had agreed to the charges that were paid on their behalf for the use of transport services. Furthermore, there was no clear account of how the charges had been calculated and what monies had been paid. In addition, people had not been supported to place their savings in interest-bearing accounts. These oversights meant that people had not been robustly safeguarded from the risk of financial abuse.

We have told the provider that it must make improvements to ensure that the service is safe. These are necessary so that financial matters are handled correctly.

Is the service effective?

We found that the provider did not have a robust system for calculating the number of staff that needed to be on duty to reliably and promptly provide people with the care they needed. In addition, there had been a limited number of occasions when planned shifts had not been filled. Although these shortfalls had not resulted in people experiencing any harm, they foreseeably increased the risk of this happening.

We have said to the provider that it may find it helpful to address these problems in the service's staffing arrangements. This is advisable so that people can be reassured they will receive the care they need.

Is the service well led?

We found that the provider did not have robust arrangements to consult with people who used the service and other stakeholders about their experience of using the service. This had reduced its ability to develop the service, including taking steps to extend the range of occupational and social opportunities offered to people.

We saw that the provider had not completed robust quality checks. This shortfall had contributed to problems with the facilities and services people received not being quickly put right. These included the difficulties we have noted in relation to occupational and social activities, management of people's finances and the standard of the accommodation. Inadequate quality checks had reduced the provider's ability to ensure that people consistently received safe care in a comfortable setting.

We have told the provider that it must make improvements. These are necessary to ensure that the service is well led so that stakeholders are consulted and robust quality checks are completed.

In this report the name of a registered manager appears who was not in post and not managing the regulated activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

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. The summary describes what we observed, the records we looked at and what people using the service and staff told us.

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

Is the service safe?

People were cared for by staff who were trained and supported to deliver care safely and to an appropriate standard.

Where people could not make decisions for themselves we saw there was a system in place to make sure any decisions would be made in their best interests.

The manager told us no applications had been needed or made by the home to restrict anyone's liberty in any way. This would usually be done to protect the person or others under the Deprivation of Liberty Safeguards (DoLS).

The provider had appropriate arrangements in place to manage medicines. This meant that people were protected against the risks associated with medicines.

There were up to date arrangements in place deal with emergencies such as the failure of essential services such as gas or electricity and fire or flooding. This meant that people could be confident that their accommodation and care needs would be reliably met.

Is the service effective?

Each person has a plan of care in place which set out the support they needed and wanted. Records showed care plans were reviewed and amended when people's needs changed.

Staff demonstrated they knew about people's needs, wishes and preferences in detail and we saw they provided the support and care that was set out in people's plans.

Records showed people received support with their healthcare needs from a range of professionals such as doctors, dieticians, opticians, physiotherapists and speech and language therapists. Records also showed people had access to specialist behaviour services and occupational therapy services

Throughout the visit we observed staff supported people to manage challenging behaviours in an effective and respectful manner. We saw people calmed quickly and were able to continue with their usual daily routines.

Is the service caring?

We saw staff communicated with people using their preferred methods and in a friendly and respectful manner.

We also saw that people responded positively to staff and they appeared comfortable and relaxed in their company. Staff provided care and support in an unhurried and timely way.

People we spoke with said things like, 'I love the staff, they're nice to me' and 'Look they're always working; always helping us; this is my home.'

Is the service responsive?

We asked people what they would do if they were unhappy with anything in their home. One person said, 'I tell the staff and they sort it out for me.'

Two complaints about the service had been received since January 2014. Records showed both complaints had been managed in line with their policy. We saw the manager and provider had used the outcomes of the complaints to make changes to the way, for example, medications were managed. We also saw the provider had shared the lessons they learned with other services within their organisation.

Is the service well-led?

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

We saw people who lived in the home were encouraged to express their views about the way things were done by way of meetings and surveys. The views of visitors to the home were also sought through surveys. We saw the provider used this information to make changes to the way the service operated.

Staff told us they felt able to raise issues with the provider and manager, and felt they were listened to. They told us they received regular supervision which helped them plan their development within their work role. One staff member said the manager was, 'Brilliant.'

During our visit we spoke with a member of staff and the interim manager. We also looked at three records and observed care.

Overall we saw people were supported by skilled and experienced staff who understood their roles and responsibilities.

We observed care and saw staff were responsive to people and interacted with them positively.

People were cared for in a clean and tidy environment and were protected against the risk of infection.

When we spoke with staff they told us they had received training to enable them to provide safe and appropriate care to people. We saw the provider had processes in place to ensure staff had the skills and experience necessary to be able to respond to people's needs.

We looked at records including personal care plans. We spoke to the manager and staff who were supporting people and we observed how they provided support. We saw people were enabled to make choices and decisions for themselves, for example, choice of meals.

We saw people were treated with respect and dignity and had a good rapport with staff. People told us they would feel comfortable to tell staff if they had any problems. They made comments such as 'The staff are nice.' and 'I like it here.'

People told us their bedrooms were comfortable. We saw they were furnished and equipped to meet people's individual needs. Visitors told us they were always made to feel welcome.

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We spoke to the manager about making sure some maintenance issues received attention.