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Inspection carried out on 19 February 2019

During a routine inspection

About the service:

This service is a care home. It provides care for older people, some of whom have nursing needs and some of whom are living with dementia.

People’s experience of using this service:

¿ We received positive feedback about the service and the care people received. The service met the characteristics of Good in all areas.

¿ People received safe care. Medicines were managed safely and there were enough staff to support people and keep them safe.

¿ People were supported by skilled staff with the right knowledge and training.

¿ Staff had respectful, caring relationships with people they supported. They respected people’s dignity and privacy and promoted their independence.

¿ People’s care and support met their needs and reflected their preferences. The provider upheld people’s human rights.

¿ Effective quality assurance processes were in place to monitor and improve the quality of the service. There was a positive, open and empowering culture.

Rating at last inspection:

The rating at the last inspection was requires improvement (5 April 2018). The overall rating for the service has now improved to Good.

Why we inspected:

This was a planned inspection of the service based on the last rating.

Follow up:

We did not identify any concerns at this inspection. The provider had made the required improvements to achieve a rating of Good. We will therefore re-inspect this service within the published timeframe for services rated Good. We will continue to monitor the service through the information we receive.

For more details, please see the full report which is on the CQC website at

Inspection carried out on 2 January 2018

During a routine inspection

This was an unannounced inspection, which took place on 2 and 3 January 2018. Cherry Blossom Manor is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Cherry Blossom Manor accommodates up to 77 people in one adapted building. The building has two storeys built around a secure inner courtyard. The upstairs floor specialises in providing care to people living with dementia and was called Memory Lane. At the time of the inspection, 55 people were living at the service. The provider had closed a section of Memory Lane as it was not used. The home caters for people who require residential, nursing and respite care.

The home did not have a registered manager. 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 general manager had recently been appointed. They were in the process of becoming registered.

At the last inspection 25, 26 February 2016 the provider told us they would evaluate findings from their plan to ensure staff were deployed appropriately to meet people’s needs. At this inspection we found that this had not happened. There was a new regional director in post and a new general manager who had not seen this evaluation. At this inspection we found people and staff had mixed views about the staffing levels within the home. Improvement was needed around how staff were deployed at meal times and other peak times to make sure people got the person-centred support they required. Whilst the service had introduced a new shift to support evenings other peak times required review.

At our last inspection, we identified that people’s social needs were not always being met, people were at risk of social isolation because staff did not always have the time to sit and talk with them. We found that this had not improved. Views about activities were mixed. Some staff and relatives told us activities were not always available on Memory Lane, which meant that people who lived there could not always follow their interests.

This service had been rated as requires improvement in February 2016 and at the previous inspection in March 2015. This is therefore the third time the provider has failed to meet the standards required.

Quality monitoring had been completed in a range of areas however; the monitoring had not identified the issues that we found during this inspection.

Risks to individuals were identified and recorded and risk management plans were in place to reduce those risks. Improvement was needed to some records to make sure all staff intervention was being recorded consistently.

People were supported by staff that had the skills and knowledge to support them and meet their needs. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. Where people lacked capacity the service operated within the principles of the Mental Capacity Act 2005.

People had good relationships with staff and were supported in a kind and caring manner. People were involved in making decisions. Staff were respectful of decisions made and maintained people’s dignity.

People’s changing needs were responded to. People had access to health professionals and other specialists if they needed them in a timely way.

People were protected from potential abuse by staff that were trained and understood how to safeguard them.

Medicines were managed safely, staff were trained to administer medicines and people received their prescribed medicines.

There were safe recruitment practices in place, which ensured appro

Inspection carried out on 25 February 2016

During a routine inspection

This inspection took place on 25 and 26 February 2016 and was unannounced. Cherry Blossom Manor provides nursing and personal care for up to 77 people, including those living with dementia. At the time of our inspection 63 people were living in the home. Cherry Blossom Manor is a two storey building built around a secure inner courtyard.

The home had a registered manager. 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, their relatives and staff told us staffing levels were not sufficient to meet people’s needs. Although rosters indicated that sufficient staff were on duty, it was not clear that they were always deployed appropriately to meet people’s needs and wishes promptly.

Staff training had been affected by the lack of a trainer to deliver and drive training in the home. The registered manager was aware of the training that required updating, and had planned for this to be completed. Staff were supported to develop their skills and knowledge to effectively support people through their old age and end of life needs.

People were protected from the risk of abuse. Staff understood indicators that may indicate abuse, and how to raise their concerns. The provider and registered manager investigated safeguarding concerns robustly. They had shared learning with staff and implemented actions to protect people when an issue was identified.

People were protected from health and environmental risks. Risks associated with people’s health or wellbeing were reviewed regularly to ensure these risks were managed safely. Environmental checks and servicing protected people and others from potential risks in the home.

People were protected from risks associated with their medicines, because nurses followed safe practices to administer their medicines safely.

The registered manager had completed all required pre-employment checks to be assured people were supported by staff suitable for their roles.

People’s consent was sought for the care they received. Where they lacked the mental capacity to make informed decisions about their care, these were legally made on their behalf by those who could represent their needs and wishes. Conditions on authorisations to deprive people of their liberty in order to keep them safe from harm were lawfully met.

People were supported to maintain a healthy and nutritious diet. Their preferences were known and used to encourage people to eat and drink sufficiently.

People's health needs were known and monitored to ensure they were attended by health professionals when necessary. Staff followed guidance to ensure people’s health needs were managed effectively.

People and their relatives described staff as caring and friendly. People were involved in decisions about their care, and were reassured when they became anxious. Visitors were welcomed to visit at times suitable for them. People’s dignity and privacy were respected and promoted by the staff who supported them.

People’s care was reviewed regularly to ensure staff were responsive to their changing needs. Activities and communal areas including a café provided opportunities for people to socialise and interact with others.

People and their relatives were encouraged to provide feedback, and were aware of the process to resolve any concerns and complaints. Feedback was used to inform changes to improve the quality of care people experienced.

Staff were held accountable to deliver their roles effectively. Staff who excelled in their roles were celebrated and rewarded. The registered manager spoke of the support she experienced from the provider, and valued the hard work her staff team invested in the home. Staff told us team work and organisationa

Inspection carried out on 5 and 10 March 2015

During a routine inspection

The inspection took place on 5 and 10 March 2015 and was unannounced. Cherry Blossom Manor provides residential care for up to 77 older people, including people living with dementia. At the time of our inspection 61 people were living in the home.

The home consisted of two floors. The top floor, known as Memory Lane, cared for people living with dementia. The ground floor accommodated people with personal care needs and people living with the earlier stages of dementia. Some people were on short term re-ablement and respite placements to support them to regain the skills and independence required to return to their own homes.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

During this inspection we checked whether the provider had taken action to address the three regulatory breaches we found during our inspection in August 2014. The provider told us they would complete the actions required by the end of November 2014, and we found the home was no longer in breach of the regulations.

Not all staff had completed training in the required subjects identified by the provider to ensure they could carry out their roles effectively. Staff had not always been supported through regular supervisions. However, there was evidence that staff were appropriately supported through the registered manager’s open door policy and other opportunities to discuss concerns. Plans shared by the registered manager demonstrated that training and supervisory meetings would be up to date by the end of March 2015.

People’s care records demonstrated that staff received appropriate guidance to meet people’s specific health needs effectively. Robust recruitment checks ensured new staff were suitable to support people safely.

People and relatives did not always feel there were sufficient staff available to meet people’s needs promptly. Staff told us unplanned absences affected their workload, although they ensured the impact of this did not affect people’s care. The registered manager demonstrated that staffing levels were planned to meet people’s identified needs. When short notice absences reduced staffing levels below the required minimum, measures had been taken to ensure the busiest times of each shift were covered. Where agency staff were used to cover staff absence, the registered manager promoted continuity of care by using agency staff on long term contracts when possible. Agency staff we spoke with had a good understanding of people’s needs, and knew each of them individually.

People told us they felt safe in the home. Staff understood and followed the provider’s policy to safeguard people from the risk of abuse, and were confident of reporting procedures should they have concerns.

People confirmed that they received their medicines on time. Medicines were administered, stored and disposed of safely. Equipment was checked and serviced in accordance with manufacturers’ guidance to ensure people, staff and others were not placed at risk of harm. Guidance was in place to ensure staff understood their roles and responsibilities in the event of incidents and emergencies.

People’s rights and wishes were promoted through effective implementation of the Mental Capacity Act 2005. Staff understood the actions to take if a person was assessed as lacking the mental capacity to make an informed decision. The registered manager understood and followed the requirements of the Deprivation of Liberty Safeguards when people had been identified as needing restrictions to protect them.

People told us they enjoyed the food provided, and were offered alternatives if they did not like the choices available. Staff were aware of those at risk of malnutrition and dehydration, and effectively supported people to maintain a healthy dietary intake.

Communication within the home effectively ensured people were supported through a network of health professionals as required. People on short term placements were enabled to return to their own homes, as staff supported them to build their confidence and independence.

People described staff as caring and polite. We observed staff treated people with respect. They took care to promote people’s dignity and privacy. They listened to people’s wishes, and supported them as they wished. Where people were unable to verbally communicate their wishes, staff used aids, such as plated meals or other objects of reference, to help people indicate their preferences.

People’s needs were reviewed with them on a monthly basis. Assessment tools ensured people’s changing needs were documented and addressed. Risks to people’s health and wellbeing were identified and assessed to ensure people and others were protected from potential harm.

People and those important to them had opportunities to influence the service through comments books and quarterly residents and relatives meetings. There was evidence that the registered manager considered comments raised and took actions to address people’s concerns. Formal complaints were managed in accordance with the provider’s policy to reach resolution, and the findings from these were shared with the complainant.

People told us they thought the home was well managed. Staff recognised improvements made within the home, but did not always experience support and appreciation. They did not unanimously consider that issues and concerns they had raised had been addressed or resolved effectively.

Audits of the quality of care people experienced demonstrated that improvements had been made, but further improvements were required to meet the provider’s policies and procedures, such as the completion rate of training and supervisory meetings.

The provider’s values were embedded in the home, and demonstrated by staff and managers. Feedback from people, relatives, commissioning and monitoring authorities and others was used to inform reflection and learning to improve the quality of care people experienced. A central action plan ensured progress was monitored and owned by the registered manager and regional management team. This ensured required actions were regularly reviewed until completed, and those in positions of authority were held to account for the actions required.

Inspection carried out on 28 August 2014

During a routine inspection

The inspection team consisted of two adult social care CQC inspectors and an expert by experience. This is a person with experience in a specialist area of care, such as awareness of dementia care. On the day of our inspection 60 people used the service. We spoke with seven people and nine relatives and friends of people, eight care workers, nurses and other ancillary staff, the registered manager and the deputy manager.

This service is currently registered with the CQC to provide the regulated activities of accommodation for persons who require nursing or personal care, treatment of disease, disorder or injury, and diagnostic or screening procedures. However, the regulated activity of diagnostic or screening procedures was not being provided at the time of our inspection. The manager told us the service was de-registering for this activity.

Information of concern had been brought to our attention regarding recruitment, staffing levels and appropriate care and treatment for people. We considered these concerns as part of our inspection. We observed how staff supported people, and looked at documents including care plans and management reports. We considered all the evidence we had gathered under the outcomes we inspected. We used this information to answer the five questions we always ask; is the service caring, responsive, safe, effective and well led? This is a summary of what we found.

Is the service caring?

The service was caring. People described staff as �Wonderful and loving�, �Caring� and �Very good�. None of the people we spoke with spoke badly of staff. Relatives also spoke positively about staff, and told us they were approachable. We observed staff interacted with people with patience and care. They supported people at a pace appropriate to the individual, and provided reassurance when they observed people were anxious.

Is the service responsive?

The service was responsive to people�s needs. Relatives told us the management team were approachable, and open to discussion of concerns. A nurse told us �We have to find out the little things people like, and understand that likes can change. So we try different things�.

We saw that staff were observant of people�s needs, and understood when these changed. People�s health and wellbeing had been monitored, to ensure changes such as weight loss or temperament changes had been identified promptly. This ensured that people received the care they required. However, we did not see guidance for staff to manage all of people's identified health needs. For example, we saw that management of people�s diabetes did not provide sufficient information to ensure staff understood actions to take in the event of a medical emergency related to this illness.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring people�s care provision promotes their safety and welfare.

Is the service safe?

Some areas of the service were safe. We found the provider had started to implement an effective system to identify, assess and manage risks to people�s health, safety and welfare. The provider had reviewed people's risk assessments to reflect changes in their needs.

Concerns had been raised with CQC regarding insufficient staffing levels to meet people�s identified needs. We found there were sufficient staff on duty on the day of our inspection, and on rotas we looked at for July and August 2014. Staff told us they were busy, but that there were usually sufficient staff on duty to meet people�s needs. They told us the situation had improved recently. The manager demonstrated how they had assessed and reviewed people�s needs, considered the layout of the service and understood staff skills, to ensure sufficient staff with the skills required were rostered for each shift. They used agency staff to cover shifts when necessary to ensure sufficient and suitable staffing availability.

We did not find that all required recruitment checks had been completed before staff commenced work at the service. For example, we found gaps in applicants� employment history had not been identified or investigated, and reference of good character had not been requested from all previous employment positions where the applicant had worked with vulnerable adults or children. The impact of this was that staff employed may not have been suitable for their role.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to requirements relating to workers.

Is the service effective?

The service was effective in most areas. We found issues affecting people�s care and welfare had been identified, and appropriate measures had been implemented to improve people�s wellbeing. For example, accidents and incidents had been recorded and reviewed to ensure issues and trends had been identified, and actions taken to reduce the risk of repetition.

However, we did not find that staff had been suitably supported to complete and refresh all mandatory training required by the provider. Not all staff had attended regular individual supervisory meetings to discuss issues, concerns and aspirations to promote their development and understanding of roles and responsibilities.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to supporting staff.

Is the service well led?

We found the service to be well led. The registered manager and deputy manager were present at the service daily, and an on call service ensured 24 hour contact for staff if they had concerns or required management guidance. People and their relatives told us they could speak with managers when they wished to, and stated that managers were approachable. Audits of the service had been completed to ensure that the quality of the service provided had been monitored and met the required standard.

Inspection carried out on 5 November 2013

During a routine inspection

At the time of our inspection the registered manager was not available; we spoke with the acting manager. We also spoke with four staff, five people who used the service and two relatives.

We found that people were treated with dignity and respect. They were offered choices and encouraged to make decisions. The provider took note of people�s capacity to make decisions and ensured they were supported appropriately.

People�s needs were assessed and care and support was given in line with their needs. One person said to us �this is the Rolls Royce of places.� Another said �I have absolutely no complaints, they look after me well. The food is good, I enjoy it.�

There were appropriate arrangements in place for management of medications. Processes were followed to ensure the safe storage and administration of medication.

There were sufficient qualified, skilled and experienced staff to meet the needs of the people living in Cherry Blossom Manor.

The provider had an effective system to regularly assess and monitor the quality of the service that people receive.

Inspection carried out on 1 February 2013

During a routine inspection

On the day of the inspection there were 50 people living in the home. We spoke with five members of staff, seven people living in the home, family members visiting the home and examined records, surveys and meeting minutes. One person living in the home told us "I couldn�t be treated better at Buckingham Palace". Another person who lived there said �The staff are more like family than staff�. A family member visiting told us "The staff are always cheerful and keep me and my brother involved in my Mum�s care, and I feel that people are respected here."

We found that people and their representatives had been involved in planning their care. We saw that the staff were familiar with people's needs and gave them opportunities to make choices.

The home had effective systems in place to ensure that safeguarding incidents were robustly dealt with. Staff were appropriately trained and were able to explain the process for reporting safeguarding incidents. There was safeguarding information displayed around the home for the staff and people using the service to refer to.

Staff had received an appropriate induction and were provided with regular supervision and appraisals. Training was appropriate to staff roles and regular refresher training was provided.

The home's quality assurance systems effectively ensured that the performance of the home was adequately monitored. The views of people living in the home and their representatives were also taken into consideration.