Cherry Tree Lodge Nursing Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People's needs were assessed and reviewed to help ensure they received appropriate care and support.

Care plans had improved since the previous assessment and generally reflected people's current health and support requirements. Assessments considered a range of factors relevant to people's care and wellbeing, and most staff demonstrated a good understanding of the people they supported.

Care plans included information about how people communicated, including some non-verbal forms of communication. People's needs were reviewed regularly, and healthcare support was sought when needed.

Relatives were generally positive about the care people received and felt staff understood their family members well. Feedback indicated people were able to access healthcare support when required and changes in people's health and wellbeing were identified and acted upon appropriately.

People mostly received care and treatment which reflected current guidance and recognised good practice.

Clinical tools were used to assess and monitor people's needs and risks, including nutritional assessments where required. People's nutritional and hydration needs were monitored and support plans included guidance to help staff meet identified risks and health needs.

People had access to relevant healthcare professionals and specialist services to support their health and wellbeing. Advice and recommendations from healthcare professionals were reflected within care records and used to guide care and treatment.

Relatives were positive about how staff responded to changes in people's health and described staff seeking medical advice and support when required. Professional feedback was generally positive regarding staff knowledge and partnership working.

Staff worked with colleagues and external professionals to support people's health and wellbeing. Teamwork within the care team was viewed positively by staff. One member of staff said, "Carers support each other. Teamwork is good." Staff described sharing information about people's needs and supporting one another when people required additional support.

Some staff described inconsistencies in communication and support between shifts. One staff member reported that when the registered manager was absent, advice and support from nursing staff could be difficult to obtain and discussions could become confrontational.

Professional feedback was mixed. A professional spoke positively about staff knowledge and partnership working and described staff as helpful and knowledgeable about the people they supported. However, another professional reported difficulty obtaining information because records were held across paper records, electronic systems and email correspondence. They told us this made it more difficult to obtain a complete and current picture of people's needs and could delay assessment processes and decisions relating to people's care and support.

People were supported to maintain their health and wellbeing and had access to healthcare services when required.

Relatives were positive about how staff responded when people's health needs changed and felt staff acted appropriately when concerns arose. People received support from a range of healthcare professionals and specialist services, with staff working alongside them to help ensure people's health needs were met.

Staff demonstrated a good understanding of people and spoke confidently about changes in people's wellbeing and the actions they would take in response. Where risks relating to health, nutrition or hydration had been identified, appropriate monitoring and guidance were in place to support staff.

However, support was largely focused on maintaining people's existing health and wellbeing. Whilst this was important, there was limited evidence that people were being supported to pursue broader health and wellbeing goals, maximise their independence or access opportunities that could further enhance their quality of life.

People's outcomes were not consistently monitored in a meaningful way to determine whether support was helping them achieve their goals and aspirations.

Whilst there were examples of personalised work to improve outcomes for people, this approach was not consistently embedded across the service. Care plans included sections relating to aspirations and outcomes, but these were often generic and focused on maintaining people's current wellbeing rather than supporting them to develop new skills, increase independence or achieve personal goals.

For many people, it was unclear what a successful outcome would look like or how progress towards this would be measured. Records did not consistently demonstrate that goals and outcomes had been identified, reviewed or evaluated.

As a result, people were more likely to receive support aimed at maintaining their current circumstances rather than helping them work towards improved outcomes and a better quality of life.

People's rights to make decisions about their care and treatment were not always fully respected in practice.

Mental capacity assessments had improved since the previous assessment and contained more information about how people had been supported to understand decisions. However, records would benefit from more detailed information about the communication methods, resources and support used to enable people to make decisions. Best interest records did not always clearly demonstrate the options that had been considered or the rationale for decisions reached. This made it more difficult to understand how decisions had been reached and whether alternatives had been fully considered before care arrangements were agreed.

During the night observations, people's apparent wishes and non-verbal communication were not recognised or responded to appropriately when support was being provided. For example, people were encouraged to continue eating and drinking despite appearing reluctant to do so. Staff did not always pause to consider whether people wished to continue or adapt their approach in response to what people were communicating. This reduced assurance that people were consistently supported to express choices and exercise their right to refuse care and treatment.

Feedback from professionals raised similar concerns. Professionals identified examples where people appeared to communicate that they did not wish to engage with support, but records did not always demonstrate consideration of why the person was responding in this way or whether the support needed to be adapted. This reduced assurance that people's choices and preferences were consistently recognised and respected.

Whilst staff knew people well and understood many of their communication methods, further work was needed to ensure people's verbal and non-verbal communication were consistently recognised, understood and respected in practice.