Cherry Tree Lodge Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The provider was previously in breach of the legal regulation in relation to safe care and treatment. Improvements were found at this assessment, and the provider was no longer in breach of this regulation, although further improvements were still required.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Learning from incidents and events was not consistently embedded across the service. Opportunities to understand why incidents had occurred and use this information to improve practice were sometimes missed.

Staff were able to describe how they would report incidents and concerns. However, staff feedback indicated information relating to incidents was not always effectively communicated. One staff member told us, "I don't get a handover. I won't know about incidents until I speak to the nurse." This limited awareness of incidents that had occurred on previous shifts.

Records reviewed did not always provide a complete account of incidents and staff responses. Information was sometimes recorded within daily notes rather than supported by a completed incident record. This reduced opportunities to fully review incidents and ensure any learning was captured and shared with staff.

Staff described occasions where concerns relating to incidents had been raised but were not always addressed as quickly as they would have expected. Feedback indicated staff often developed their knowledge and approach through experience and support from colleagues rather than through structured reflection following incidents.

People experienced continuity of care when accessing other health services and staff worked with external professionals to support people's ongoing health and wellbeing.

Relatives were positive about communication when people's health needs changed and described staff seeking timely advice from healthcare professionals when required. One relative told us, "If I tell the staff I don't think [my family member] is well, they respond immediately and contact the relevant person, GP or hospital."

People were supported during transfers between services. One relative described how their family member had attended hospital and said, "[The] carer stayed with [my family member] all the time, even though it was beyond their shift. They let me know what was going on." This helped ensure continuity of care and support during the person's hospital attendance.

Relatives felt informed about significant changes to people's health and treatment and were generally positive about the way the service worked with healthcare professionals to support people's safety and wellbeing.

People were not always supported in ways that promoted their rights, choices and freedom from restrictive practice.

Some staff did not consistently demonstrate an understanding of restrictive practice, consent and people's right to refuse support. During the evening visit, we observed a member of staff physically holding a person's forehead and moving their head backwards whilst attempting to encourage them to drink. The person's apparent wishes and non-verbal communication were not appropriately recognised or responded to. The concern was raised with leaders during the assessment and reported to safeguarding. Immediate action from the provider was taken in response.

Deprivation of Liberty Safeguards authorisations were in place where required. Restrictions in place, including the use of equipment such as lap belts on wheelchairs, were subject to review. It was recognised that where people's risks or levels of supervision changed, any restrictions should be reconsidered to ensure they remained proportionate and legally authorised.

Staff were able to describe how they would recognise and report safeguarding concerns and told us they felt comfortable raising concerns when required.

Relatives consistently told us they felt people were safe living at the service and were confident staff would respond appropriately when concerns arose.

People were not always supported through clear and personalised approaches to managing risks relating to their care and wellbeing.

Care plans had improved since the previous assessment and contained more information about what may cause people distress and how staff should support them. However, further work was needed to ensure guidance was clear and consistent.

Care plans included information about supporting people when they became distressed. However, additional detail was needed to ensure staff had clear and consistent guidance regarding the strategies that should be used and how these should be applied in practice.

Whilst some staff demonstrated a good understanding of non-verbal communication and people's right to refuse support, this was not consistently reflected across records and observed practice. Records did not always demonstrate consideration of whether a person's presentation may reflect an unmet need or a choice not to engage with support.

People were supported in a safe environment. Required environmental and equipment checks had been completed; improvements had been made since the previous assessment and fire safety arrangements were compliant. No immediate safety concerns were identified during the assessment.

However, the environment was not well maintained. Areas of the home showed signs of deterioration, including peeling wallpaper and visible filler repairs. Whilst these issues did not present an immediate risk to people, the overall appearance was not welcoming and did not support a pleasant living environment.

Equipment required to support people was available and no concerns were identified regarding its safety or use. Staff understood their responsibilities for identifying and reporting environmental concerns.

The service accommodated a relatively large number of people with a learning disability. Whilst people appeared settled and were supported by staff who knew them well, the size and layout of the service presented some limitations in creating a homely environment and promoting the personalised living experiences associated with smaller-scale models of support.

Staffing arrangements had improved since the previous assessment and additional day staff had been recruited. Day staff spoke positively about these changes and most felt increased staffing levels had reduced pressures and improved the support provided to people.

Night staff told us staffing levels were generally sufficient to meet people's needs. However, some staff felt additional support at night would be beneficial, particularly when people required increased assistance or unexpected incidents occurred. One staff member said, "Could be more staff at night to support. One more member of staff would be beneficial." Whilst another told us, "Sometimes a bit tough, but we get by." Staff described differences between shifts, with one staff member commenting that staffing was "fantastic" in the morning but "more stretched" during the afternoon when staff were required to support additional duties.

Recruitment records reviewed contained the required pre-employment checks and provided assurance that appropriate recruitment practices were generally being followed. However, a review of some longer-serving staff files identified gaps in employment histories that had not been fully explored or explained at the time of recruitment. This reduced assurance that all relevant information had been considered when assessing applicants' suitability for their roles.

Staff had access to training relevant to the needs of people using the service and told us they felt supported and spoke positively about the registered manager.

People were protected from the risk of infection. The service was clean, staff had access to appropriate personal protective equipment (PPE) and there were suitable arrangements in place for the management of infection prevention and control.

Staff were able to describe when PPE should be used and how it should be disposed of safely. Staff told us sufficient supplies were available and understood the action they would take in the event of an infectious outbreak. Cleaning arrangements were in place and the home appeared visibly clean.

Relatives were positive about standards of cleanliness within the service. One relative told us their family member was always very clean and said their skin, hair and personal presentation were consistently well maintained. Other relatives also spoke positively about people's appearance and personal care.

People received their medicines safely and improvements had been made since the previous assessment.

Medicines were stored, administered and recorded appropriately. Relatives did not raise concerns about medicines management and told us they were informed when changes were made to people's medicines. One relative said, "The staff let me know when they made an increase to [my family member's] epilepsy drugs", whilst another told us, "As far as we know [my family member's] meds are given on time."

Protocols were in place to guide staff on when medicines used to manage distress should be administered. Records showed the use of these medicines was low and reviewed regularly by relevant healthcare professionals.

However, records relating to medicines used to manage distress did not always contain sufficient detail regarding the reasons the medicine had been administered or the alternative approaches considered beforehand. In addition, support plans did not always provide clear guidance about the strategies staff should use before medicines were considered. This limited assurance that decisions to administer these medicines were consistently supported by clear evidence of need and that alternative, least restrictive approaches had been considered first.