Cherry Lodge

Cherry Lodge is a residential care home providing regulated activities of personal care and accommodation to up to 46 people. The service provides support to older people, people living with dementia and people with mental health needs. At the time of our inspection there were 34 people using the service. Cherry Lodge accommodates people in one adapted building. The home is set out over three floors with a passenger lift available to access the first and second floors of the home.

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

The provider’s systems and processes required further improvements to ensure records contained all the required information to meet people’s needs. Some people’s risk assessments required more detailed instructions for staff to keep them safe.

Accident and incident records were completed and monitored by the registered management however further work was required to ensure patterns and trends were identified and strategies put in place to reduce the likelihood of reoccurrence.

People were not always supported to be involved in activities that met their own individual needs or preferences.

Some medicines records were not up to date and care plan reviews were not always completed within agreed timescales.

Governance systems and processes were not always effective at monitoring the quality and safety of the service.

The provider had safeguarding systems and processes in place to keep people safe. Staff knew about the risks to people and followed the assessments to ensure they met people's needs.

People felt safe and were supported by staff who knew how to protect them from avoidable harm.

People received their medicines safely and as prescribed and were supported by sufficient numbers of staff to ensure that risk of harm was minimised.

Staff had been recruited appropriately and had received relevant training, so they were able to support people with their individual care and support needs.

Staff sought people's consent before providing care and support. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way and in their best interests: the policies and systems in the service supported this practice.

People's individual communication needs were considered to support them to be involved in their care.

Staff spoke positively about working for the provider. They felt well supported and that they could talk to the management team at any time, feeling confident any concerns would be acted on promptly. They felt valued and happy in their role.

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

Rating at last inspection and update

The last rating for the service was inadequate (published on 24 February 2023). This service has been in Special Measures since 24 February 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

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

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. As a result, we undertook an unannounced comprehensive inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

Enforcement and Recommendations

This inspection has identified a continued breach relating to people receiving care that is centred on them and the governance systems in place to maintain oversight of the service. We will continue to monitor the improvements within the service through existing conditions we have placed on the provider’s registration. This includes sending us monthly reports of actions the provider has taken to make improvements within the service.

We have made a recommendation about delivering meaningful activities to people.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Cherry Lodge is a residential care home providing regulated activities of personal care and accommodation to up to 46 people. The service provides support to older people, people living with dementia and people with mental health needs. At the time of our inspection there were 45 people using the service. Cherry Lodge accommodates people in one adapted building. The home is set out over three floors with a passenger lift available to access the first and second floors of the home.

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

People had not always had all of the risks associated with their care, fully mitigated. In some cases, risks had not been identified and where risks had been identified there was limited or incomplete guidance for staff to follow. People had not always received their prescribed creams. Records of cream administration had unexplained gaps in recordings.

Whilst relevant professionals were informed of incidents that had occurred there was no analysis of incidents across the service which may have identified themes and trends. In cases where learning had been taken from incidents, this learning was not always effectively implemented.

Systems around recruitment had not always been effective. We found risk assessments relating to staff members employment had not been put in place.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People were not always supported in a caring or empathic manner. Our observations showed task-based care practice where people were not routinely involved. There were missed opportunities for conversations between people and staff.

People had not been involved in planning or reviewing their care in line with their preferences. There were incomplete care records with little information of how a person may like to receive care. Activity provision was sparse, and people were not always consulted about the activities they were participating in.

The providers systems to monitor the quality and safety of the service were not effective. The inspection identified multiple shortfalls in care practice, the safety of care and in how people’s rights were being upheld. The providers systems had failed to identify and address these concerns.

People were supported by staff who understood how to recognise and escalate safeguarding concerns should they have any. People received safe support with their daily medicines and checks were carried out on staff to ensure they were competent to administer medications.

People were supported to access appropriate healthcare and any concerns relating to changes in peoples’ healthcare needs were escalated appropriately.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 24 April 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service. We undertook a focussed inspection to follow up on concerns we had identified following this review. During the inspection we identified further concerns relating to the care and support people were receiving so we widened the scope of the inspection to a comprehensive inspection reviewing all 5 key questions.

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.

Enforcement

We have identified breaches in relation to safe care and treatment, seeking people’s consent, people receiving care that is centred on them and the governance systems in place to maintain oversight of the service.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found the following examples of good practice.

¿ People were supported to maintain contact with relatives and friends who were important to them through video and telephone calls.

¿ The management team had maintained contact with relatives through emails, newsletters and telephone calls to keep them informed about the wellbeing of their family member.

¿ Personal Protective Equipment (face masks, gloves, hand sanitising gel) were available for visitors to use when entering the home.

¿ Staff changed their clothing upon starting and finishing work, to reduce the risk of cross infection. The provider washed all staff uniforms.

¿ Agency staff had been blocked booked and did not work in other health or social care settings which mitigated the risk of cross infection.

¿ Staff had been supported in a variety of ways to reduce anxiety and promote their wellbeing.

¿ People who had tested positive for Covid-19 self-isolated in line with current guidance. Clinical waste and laundry were handled in line with government guidance.

¿ Specialist cleaning equipment had been purchased to complete deep cleans of the environment. Use of the equipment meant areas that were difficult to clean could be sanitised.

Further information is in the detailed findings below.

About the service:

Cherry Lodge is a care home that provides personal care for people, some of whom are living with dementia. At the time of the inspection 43 people were living there. The home was established over three floors with communal areas that included a dining area, three lounge spaces and a large garden. The home also provides short stay interim beds (EAB) for people discharged from hospital, who may require further assessment of their care and support needs before returning to their own home or into residential/nursing care.

People’s experience of using this service:

¿ At the last inspection, we found the provider to be in breach of Regulations 11, 17 and 19 of the Health and Social Care Act 2008 (Regulations0 2014. We asked the provider to complete an action plan and send us monthly updates to show what they would do and by when to improve the key questions of Safe, Effective, Caring, Responsive and Well-led to at least good. At this inspection, we found that although some improvements had been made, some aspects of the service required further improvement.

¿ Since the last inspection, the registered manager and operations director had started to implement new processes to bring a clear and consistent oversight of operations. During the last 12 months, the service has experienced some challenges which has resulted in the loss of a number of care and senior care staff. The changes in staffing have meant that planned improvements have not always happened or have not been sustained.

¿ The provider’s governance systems to monitor and check the quality of the service provided for people were not consistently effective and still required further improvement. The management team and provider were extremely open and transparent with us about the current improvements required to the service and were enthusiastic and committed to turning the service around. Although we saw new systems and processes were being put in place to support the necessary improvements, it was too soon to comment on their effectiveness.

¿ People and relatives told us they felt the service was safe and there were sufficient numbers of staff to support people. New staff members had completed their induction training. However, there were gaps in staff training, supervisions and observations of staff practice. The registered manager had recognised these gaps and plans were in place to make the required improvements.

¿ Risk assessments and care plans were not always up to date and reflective of people's support needs and in some cases, staff were supporting people in different ways. The registered manager explained as part of the ongoing improvement plan to develop the service, the system for revising care plans was under review to ensure people were included in the process and that care reflected people’s individual needs.

¿ Staff had access to equipment and clothing that protected people from cross infection.

¿ People were assisted to have enough to eat and drink and told us the food was good.

¿ People accessed healthcare services to ensure they received ongoing healthcare support.

¿ People, as much as practicably possible, had choice and control of their lives and staff were aware of how to support them in the least restrictive way. Staff demonstrated an understanding of how to support people to make choices. There had been an improvement in the completion of mental capacity assessments and appropriate deprivation of liberty safeguard applications had been completed which meant the provider was compliant with the law.

¿ People were supported by kind and caring staff that knew them well. Staff encouraged people’s independence, protected their privacy and treated them with dignity. People were supported by staff that knew their preferences.

¿ There was a complaints procedure in place and people and relatives told us their concerns were dealt with positively.

¿ There were mixed views from people and their relatives’ concerning their involvement in providing feedback on the development of the service.

¿ Staff felt supported by the management team.

¿ People, their relatives and staff were happy with the way the service was managed and the provider worked well with partner organisations to ensure people’s needs were met.

Rating at last inspection:

Requires Improvement (report published 02 March 2018).

Why we inspected:

At the last inspection, multiple breaches of the regulations were found. We imposed a positive condition on the provider’s registration to submit monthly updates to us on how the service was improving. This was a planned inspection to check on the progress of the service in making the required improvements.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

Cherry Lodge is a residential care home providing accommodation and residential care for up to 46 people, some of which were living with dementia. The home also provides short stay interim beds (EAB) for people discharged from hospital, who may require further assessment of their care and support needs before returning to their own home. At the time of our inspection 45 people were living at the home.

It is a legal requirement that the home has a registered manager in post. There was no 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. A new manager had started at the home in July 2017 and gave us their assurances; they would submit an application to become the registered manager. At the time of writing this report, no application has yet been received from the new manager, should an application not be received, we will consider our regulatory response.

At our previous inspection in August 2016, we found that for the questions is the service safe, effective, responsive and well-led, improvement was required. At this recent inspection, although we found there had been some improvement, overall the service still required improvement.

Systems in place to monitor and improve the quality of the service were ineffective in ensuring people received a good and continually improving quality of service. The audits had not identified the issues we found and had not always been consistently applied to ensure where shortfalls had been identified, they were investigated thoroughly and appropriate action plans put into place to reduce risk of reoccurrences.

The provider’s recruitment processes were not consistently robust and did not always ensure the necessary security checks were completed to make sure persons employed by the provider were safe and appropriate to provide care and support to people living at the home.

Where people lacked the mental capacity to make informed decisions about their care, relatives, friends and relevant professionals were involved in best interest's decision making. However, mental capacity assessments and best interest decisions were not always applied consistently to clearly show what decisions people were being supported or asked to make in relation to their care. Applications had been submitted to deprive people of their liberty, in their best interests; therefore, the provider had acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People and relatives had not received satisfaction questionnaires to comment on the quality of the service being delivered. However, the management team had started to put in place systems to gain feedback from people living at the home, relatives and visitors. People, their relatives and staff told us the management of the home had improved, was organised and ‘well-led.’

Staff were trained to identify signs of abuse and supported by the provider’s processes to keep people safe. However, staff did not always follow the provider’s own safeguarding procedures when unexplained bruising or marks were noted on people’s bodies. Potential risks to people had been identified and appropriate measures had been put in place to reduce the risk of harm, although the information contained within some risk assessments was not always effectively communicated to staff. People were supported by sufficient numbers of staff. People were supported to receive their medicines as prescribed. Although protocols to support staff on when to administer medicine that was required on an ‘as and when’ basis were not in place.

Most people spoke positively about the choice of food available, although there was some inconsistency with staff not always ensuring people were given a choice of food available. People who were on food supplements could not always be sure they regularly received them, although people were supported to eat and drink enough to maintain their health and wellbeing. People were supported to access health care professionals , however, instructions left by health care professionals were not always effectively communicated to care staff. People’s health care needs were assessed and regularly reviewed. Relatives told us the management team were good at keeping them informed about their family member’s care.

People and relatives told us that staff were kind, caring and friendly and treated people with respect, although there were occasions when people’s dignity were not maintained. The atmosphere around the home was warm and welcoming. People were relaxed and were supported by staff and the management team to maintain relationships that were important to people. There had been an improvement in the provision of activities that provided opportunities to optimise people’s social and stimulation requirements. People and their relatives told us they were confident that if they had any concerns or complaints they would be listened to and matters addressed quickly.

People felt they received care and support from care staff that had effective skills to meet people’s needs. Staff received supervision and appraisals, providing them with the appropriate support to carry out their roles.

We saw staff treated people as individuals, offering them choices whenever they engaged with people. Where people had the capacity to make their own decisions, staff sought people's consent for care and treatment and ensured people were supported to make as many decisions as possible.

We found three breaches in the legal requirements and regulations associated with 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 the report.

During this inspection we found the provider had made some improvements to the service. Although we found some further improvement was still required.

Cherry Lodge is a residential long term care home providing accommodation and residential care for up to 46 people. The home also provides short stay interim beds for people discharged from hospital, who may require further assessment of their care and support needs before returning to their own home. At the time of our inspection 38 people were living at the home.

There was no 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 and associated Regulations about how the service is run. At the time of the inspection, the acting manager showed us they had started the application process to become the registered manager.

At the last inspection, we found that staff understood their responsibility to take action to protect people from the risk of abuse and harm, because the provider had systems in place to minimise the risk of abuse. However we saw that staff did not always follow the assessments to minimise the risks associated with people‘s care and this put people at further risk of injury. At this inspection we found there had been some improvement.

People were supported by a sufficient number of staff on duty to meet people’s identified needs. The provider’s recruitment processes required improvement to ensure suitable staff were recruited. People were supported by suitably trained staff.

People were supported to receive their medicines as prescribed.

At the last inspection we found the home had not been maintained to an acceptable standard of cleanliness. Although we found there had been an improvement, further improvements were still required.

At our last inspection we found that people did not participate in interests and hobbies that were personalised to their individual needs. There had been some improvement, however further improvement was required to meet people’s individual choices.

At the last inspection we found relatives had experienced inconsistencies as to the effectiveness of the complaints process. At this inspection, systems were still not in place to help the provider learn and develop the service from feedback and outcomes of complaints and required improvement.

At the last inspection we found although systems were in place to monitor the quality and safety of the service, they had not always been effective. We found there had been a slight improvement in monitoring the quality of the service but that the systems required further improvement.

At the last inspection the provider had not always recognised when the care being offered had put restrictions on people’s ability to choose and move around freely. At this inspection we found there had been some improvement.

People were supported by caring and compassionate staff who demonstrated a positive regard for the people they were supporting. Staff understood how to seek consent from people and how to involve people in their care. Although preserving some people’s dignity had not been consistently maintained.

People were able to choose what they ate and drank and were supported to maintain a healthy diet with input from dietary specialists.

People were supported to receive care and support from a variety of healthcare professionals and received treatment if they were unwell.