Cherry Tree Lodge

To ensure people’s needs were met and to not place any workforce pressures on the service, the provider had taken the decision to stop taking any new admissions into the home.

There was a procedure in place to welcome visitors to the home, face masks were available and hand sanitisers at the entrance. Visitors were asked to complete a health questionnaire and have their temperatures taken before going to the persons room they were visiting. Visitors including health care professionals were asked to show their vaccination status.

The home was spacious allowing ease for social distancing. The home had designated outside space for visiting in the garden area and the provider had turned a vacant room on the ground floor into a visiting room to provide a choice of location to the person and their visitor. The room had a patio door which led into the garden area and was accessed by visitors via an outside entrance. This meant visitors could see their loved ones without entering the building, reducing the risk of spreading COVID-19. The service layout provided simple zoning off areas in case of a COVID-19 outbreak to prevent the risk of spreading infection. The home was light, airy, uncluttered and visibly clean throughout. Cleaning products were in line with government guidance and available throughout the home.

Personal Protective Equipment (PPE) was in plentiful supply and the home had several PPE stations around the home to ensure staff always had access to PPE. Hand sanitizer was available at the entrance of the home and throughout the service. Staff had completed training supplied by local Clinical Commissioning Groups in the safe ways of donning and doffing PPE. Relatives told us they wear asked to wear masks when inside the home and told us staff wore PPE.

People told us they felt safe and well cared for. People were comfortable with staff and visitors wearing masks and understood it was to prevent the spreading of infection.

The home had routine testing in place for staff and people using the service.

Further information is in the detailed findings below.

Cherry Tree Lodge is registered to provide accommodation and personal care for up to 20 people . People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At our previous inspection of the home, published in October 2017, we found the service was not compliant with The Mental Capacity Act 2005 (MCA) and we agreed with the registered manager some other minor improvements. At this inspection the provider had complied with our requirement and made improvements in the areas agreed.

The registered manager/provider had worked at the service for many years. 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.

People were treated with kindness, respect and compassion, and their privacy and dignity was upheld.

People were protected from neglect and abuse. Risks were assessed and people were supported to stay safe with the least possible restriction on their freedom. Pre-employment checks were followed to ensure candidates were suitable to work in a care setting.

People’s physical, mental health and social needs were comprehensively assessed, and care and support was planned and delivered in a personalised way to meet those needs.

We identified at the inspection that fire safety was compromised by fire doors not being closed. The registered manager took immediate action, purchasing equipment so that doors could be left open at people’s request.

People, and where appropriate their families, were involved in decisions about their care and support.

Relatives and friends could visit when they wished without notice.

The service had made positive links with the local community.

People had access to meaningful activities and were encouraged to follow interests and hobbies.

People were involved in menu choices. Mealtimes were relaxed and sociable occasions, with people receiving the support they needed to eat and drink at their own pace. Dietary needs were assessed and referrals made to dieticians or speech and language therapists as appropriate.

People were supported with their health care needs.

There were sufficient appropriately trained staff on duty to support people in a person-centred way. The service used regular agency staff, whom people knew, to fill any gaps in the rota.

Staff were supported through training, supervision and appraisal to perform their roles effectively.

Staff were valued, respected and supported to develop the service, through supervision, team meetings and ad hoc conversations with the management team. The service was open to the concerns of staff, whether through whistleblowing, supervision and staff meetings, or staff surveys.

Accidents, incidents or near misses were recorded and monitored for developing trends.

The premises were clean and well maintained. Individual bedrooms were furnished and decorated according to people’s preferences.

People were protected from the spread of infection.

Medicines were stored securely and managed safely.

The service sought to support people to have a comfortable and dignified death when nearing end of life.

Clear information about how to make a complaint was available for people. Complaints were taken seriously and investigated openly and thoroughly.

The service worked in partnership with health and social care professionals and other organisations, to ensure people’s care needs were met and that staff kept up with good practice.

The provider had quality assurance processes in place, which helped to maintain standards and drive improvement.

This was an unannounced comprehensive inspection carried out by one inspector on 4 and 5 July 2017. We last inspected the home in April 2015 when we found no breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

At this inspection we found the registered persons had not taken action to fully address a recommendation made at the last inspection concerning The Mental Capacity Act 2005. There was still a need for better understanding and implementation of the Act and we made a requirement for improvement.

There was a registered manager at the home at the time of the inspection. 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.

An environmental risk assessment had been carried out and the registered manager agreed to having radiator covers fitted to eliminate the risk to people of receiving burns or scalds.

There were robust recruitment procedures in place to make sure suitable people were employed.

There was a positive culture and morale at the home, however, for there to be better governance of the home, clearer leadership and definition of responsibility between the registered manager and providers recommended.

Staff had been trained in safeguarding adults and were knowledgeable in this field.

Risk assessments had been completed to make sure that care and support was delivered safely with action taken to minimise identified hazards.

Accidents and incidents were monitored to look for any trends where action could be taken to reduce likelihood of recurrence.

There were sufficient staff employed at the home to meet the needs of people accommodated.

Medicines were ordered, stored, administered and disposed of safely and overall there was good management of people’s medicines.

The staff team were both knowledgeable and well trained and there were induction systems in place for any new staff.

Staff were well-supported through supervision sessions with a line manager and an annual performance review.

People were provided with a good standard of food, appropriate to their needs. Action was taken in circumstances where people had lost weight.

Relatives, staff and people were positive about the standards of care provided at Cherry Tree Lodge. People were treated compassionately as individuals with staff knowing people’s needs.

People’s care and support needs had been thoroughly assessed and care plans put in place to inform staff of how to care for people. The plans were person centred, covered people’s overall needs and were up to date and accurate.

A programme of activities was provided to keep people meaningfully occupied.

There were complaint systems in place and people were aware of how to make a complaint.

Should people need to transfer to another service, systems were in place to make sure that important information would be passed on.

There were some systems in place to audit and monitor the quality of service provided to people. It was agreed that more in depth auditing would be carried out in order to better monitor the quality of service provided.

The evidence we read, saw and heard confirmed that people were supported in promoting their independence and community involvement.

We looked at peoples' care plans, and saw that these included a visual diagram of the person's history and dreams and wishes for the future. One of the members of staff told us "It gives us something to talk about. It's a point of reference if someone's having a down day. I can think about those things that they want to do and try to cheer them along."

There had been no notifications of concerns of abuse regarding people who used the service, but we looked at a policy which identified the types of abuse which might occur and the action to be taken if there was a concern. Discussion with staff confirmed that they understood the policy's description of abuse and the action to take if they had a concern.

We looked at the staff files for evidence that people who used the service could be confident that staff were appropriately recruited, trained and supported to provide care and treatment. We saw how this was, currently, being provided and heard about plans to make this more effective.

We looked at systems which ensured the provider would take account of feedback, incidents and complaints and saw evidence that these were in place.