Cherrywood House

Cherrywood House is a residential care home providing personal care for to up to 14 people with a learning disability and/or autistic people. The service comprises of the main house and 3 self-contained flats. At the time of our inspection there were 11 people using the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

The service design and model did not fully meet the principles of Right support, right care, right culture’. This is because the building is larger than what is usually considered practicable to provide person-centred care and support. The service was registered with us prior to the Right support, right care, right culture’ guidance was implemented. The provider had taken action to address this by accommodating less people than they are registered for. Three people had self-contained flats and one person in the main house had their own lounge and kitchenette alongside their bedroom.

The service did not always give people care and support in a clean and well-maintained environment. The manager and provider had plans in place to address this. People had a choice about their living environment and were able to personalise their rooms.

People were supported by staff to pursue their interests. Staff supported people to achieve their aspirations and goals. The service worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative. Staff did everything they could to avoid restraining people. The service recorded when staff restrained people, and staff learned from those incidents and how they might be avoided or reduced.

People were supported to have maximum choice and control of 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. Staff communicated with people in ways that met their needs. Staff supported people with their medicines in a way that achieved the best possible health outcome.

Right Care

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. People who had individual ways of communicating, using body language and sounds could interact comfortably with staff and others involved in their care and support because staff had the necessary skills to understand them. Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.

Right Culture

The systems to monitor the quality of the service were not fully effective in ensuring shortfalls were actioned. Staff vacancies were high, vacant shifts were covered with regular agency staff. Permanent and regular agency staff knew and understood people well and were responsive to their needs. Staff morale had been low, the manager and provider had plans in place to address this. Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 13 October 2017).

Why we inspected

We received whistleblowing concerns in relation to the environment, cleanliness, people’s dignity and the culture of the service. During the inspection we identified concerns relating to cleanliness and the environment. The provider had identified these concerns and was taking action to address them.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. Please see the safe and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cherrywood House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Cherrywood House provides accommodation and personal care for up to 12 people who have a learning disability, autism and communication difficulties. Ten people were living at the service at the time of our inspection. One of these people lived in a self contained flat in the service. The other people had individual bedrooms and shared communal areas.

We found the following examples of good practice.

• People were supported to keep in touch with families and visits were planned and well organised to reduce risk and avoid the potential spread of infection. Visitors received information before coming to the service so they know what to expect. This included signing a health declaration and wearing the personal protective equipment (PPE) which was provided. People had a document in their care records entitled 'My Visiting Plan' which reviews individual risks and provides guidance to ensure people and visitors are protected as far as possible.

• A social story had been created about ‘Cory the Corona’ to share information about coronavirus in an accessible way. Creating a character helped people’s understanding and shared information meaningfully. This supported them to follow infection control measures and social distancing requirements.

• Staff had carried out individual assessments about Covid testing for people who did not have the capacity to give informed consent. Risk and context was considered, as well as distress to the person and the wishes of the family. This ensured testing was carried out in the person’s best interest.

• Staff were supported by regular supervision and contact with the registered manager and senior staff. Risk assessments had been carried out for those who were in high risk groups. When staff were on sick leave, the manager kept in contact with them and data is regularly sent to the provider to ensure all absence is monitored. On returning to work, a risk assessment was carried out with staff to ensure they were safe and able to resume their role.

• Staff had received additional infection prevention and control (IPC) training, and the local IPC lead was planning to attend additional training. Plans were also in place for staff to receive training in RESTORE2. This training supports staff to recognise physical deterioration in a person, act appropriately and carry out physical observations to ensure the person receives timely support and safe care which meets their individual needs.

• Contingency plans were in place to manage ongoing or future outbreaks or other events effectively. The provider collected data and regular reports from the service. This information was analysed and used to inform future incident management and support learning.

Further information is in the detailed findings below.

The provider wrote to us in July 2016 and told us how compliance with these regulations would be achieved. During this inspection we found improvements had been made.

Cherrywood House provides accommodation and personal care for up to 14 people who have a learning disability, autism or mental health needs. It does not provide nursing care. At the time of this inspection there were 10 people living at the service. Two of these people lived within individual flats that had their own bathrooms, toilets, kitchens, lounges and bedrooms. There were eight people who lived in the main house at the time of inspection.

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 registered manager was not the registered manager in post at our previous inspection and had commenced employment in Cherrywood House in November 2016.

People were now supported by sufficient numbers of staff. People and staff told us there was sufficient staff on duty that ensured people’s care and social needs were met. We made observations to support this. People received their medicines as required and there were processes to safely manage ‘as required’ medicines. Recruitment procedures were safe. Staff understood how to identify and respond to suspected or actual abuse and knew how to report matters internally and externally. People’s risks were identified, assessed and managed through guidance. There were systems to ensure regular maintenance and servicing of the environment and equipment was undertaken.

People received effective care from staff when they needed it. Staff received training and understood the principles of the Mental Capacity Act 2005 and empowered people through choices. The registered manager was aware of their responsibilities in regards to the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the capacity to consent to care or treatment or need protecting from harm. People had access to healthcare professionals as required. People received support to eat and drink sufficient amounts and we saw that where needed staff followed professional guidance for weight management. New staff received an induction in line with nationally recognised standards and ongoing training and supervision was provided.

Staff were caring and people and their relatives spoke positively about staff. No concerns about the staff were raised. We made observations that supported people’s comments, with staff supporting people in a person centred way in accordance with the preferences. Staff we spoke with understood the people they supported well and this was reinforced through our observations and how we observed staff interacting with people. People’s privacy and dignity was respected, and when possible people were encouraged to be independent.

The service was responsive to people’s needs. People were encouraged to undertake activities and access the wider community. There was sufficient staff to support people to do this. The registered manager had ensured that where people were less social, events were arranged in the service. People’s care records contained current information that was person centred. People had allocated keyworkers who ensured their needs were met. People’s communication needs and preferences were recorded.

The service could demonstrate they were responsive to people’s changing health and social needs. Supporting evidence showed that reactive care plans were completed to reduce immediate risks to people and staff when the need was identified. People had the opportunity to attend monthly “Your Voice’ meetings to express their views and make requests. The service had a complaints procedure and we saw that complaints had been responded to in line with procedure.

People and their relatives said the service was well led. The registered manager had ensured that legal notifications had been sent to the Care Quality Commission as required. Staff we spoke with commented positively about their employment and the leadership at the service. They also told us they felt there was a strong and effective staff team that met people’s needs. There were systems to communicate with staff through meetings. There were internal and external governance systems in operation to monitor the quality of the service provided.

Cherrywood House provides accommodation and personal care for up to 14 people who have a learning disability, autism and or mental health needs. It does not provide nursing care.

At the time of this inspection there were 14 people living at the home. Cherrywood House has two individual flats that had their own bathrooms, toilets, kitchens, lounges and bedrooms. There was 12 people who live in the main house. There is also a kitchen, dining area, a lounge, music room, an art room, an office, communal bathrooms and toilets. There is a front garden and private park area opposite the home and a patio and outdoor seating area gated from the drive way.

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 registered manager was present during the second day of the inspection.

People were not always supported by adequate staffing levels which affected their daily activities and access to the community. Staff supported people in a kind and caring manner. Staff demonstrated they knew people well, felt supported and felt able to raise any concerns with the management. People were supported by staff who had appropriate checks in place prior to commencing their employment.

People felt the home was safe. Care plans had detailed risk assessments and guidelines in place for staff to follow. People received their medicines safely and when required by staff who had received training. People were involved in their care planning and had support and assistance to access appropriate health professionals when their needs changed. People who were unable to consent to their care and treatment had completed assessments that involved significant others.

People were supported by staff who received regular supervision and training to ensure they were competent and skilled to meet their individual care needs. The registered manager was passionate about keeping people safe and ensured training was up to date following any incident. People were able to receive visitors whenever they wished. Relatives felt able to visit as often as they liked and people often visited their parents at weekends.

People’s views on the service were sought so improvements could be made. People felt happy to raise a complaint with the registered manager or the deputy manager. There was a quality assurance system that monitored the service and identified areas for improvement. Staff were recognised and rewarded for going the extra mile and their continuous service. They told us they felt happy and supported.

We found 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 this report.

At our last inspection on 6 and 9 September 2013 we had concerns about cleanliness and hygiene in the home's wet room. We carried out this inspection to check that appropriate improvements had been made.

At this inspection we found all areas of the home were clean and fresh. The wet room had been deep cleaned and a new extractor fan had been installed. The room was clean and stain free. There was no sign of damp on the walls or ceiling. There were effective systems in the home to reduce the risk and spread of infection.

When we last visited the home people had restricted access to certain areas due to renovation work following an electrical equipment fire. This impacted on people's independence and choice. We checked on this standard as part of our follow-up inspection.

We observed all areas damaged by the fire had now been redecorated and refurnished to a good standard. People were free to access all communal areas as they wished.

People told us staff respected their privacy, dignity and independence. One person said 'They are kind and polite'. Another person said 'I can have a laugh with the carers. No one treats me badly'. We heard staff speaking to people in a friendly and respectful manner. We observed staff knocked on people's doors and waited to be invited in.

People had their care and support planned and assessed regularly by staff and other professionals to ensure it met their needs. We saw that people were relaxed and comfortable with other people living in the home. People spoken with told us they were happy living at Cherrywood House.

People had varying levels of communication and support needs. The majority of staff had a good understanding of people's needs and knew how to support people in an emergency.

We had been informed that Cherrywood House had a fire in the main part of the house in July 2013. This had caused significant damage. Parts of the house were therefore not in use at the time of our inspection whilst renovation work was carried out.

We found there was a risk that people may acquire an infection due to a poor standard of hygiene and cleanliness in one of the home's wet rooms.

People told us they knew what to do if they were not happy with their care. They also told us they were always asked for their consent before staff supported them with any care or treatment.

There were suitable arrangements in place to safely administer medicines to people.

Staff felt well supported by management and could discuss any aspects of their role either through team meetings or supervisions.

People we spoke with told us they were 'very happy to live here' and 'I like my room'. They said the staff were 'friendly and always willing to help'.

People in the service told us they felt safe and could to talk to staff if they had any concerns. Staff received regular safeguarding training and were knowledgeable about keeping people safe.

People who used this service received a good quality of care and support. People were encouraged to express their views and were involved in their care. We observed that staff were caring and took time to speak with people, listened to them and responded to their needs.

Care plans reflected each person's needs and wishes and families were encouraged to be involved where possible.