Cherry Blossom Care Home

Cherry Blossom Care Home provides all single bedrooms, suitable communal rooms and access to an enclosed rear patio garden with summer house.

We found the following examples of good practice

The registered manager told us that a range of policies required updating and that the provider was looking at how best that could be achieved. They understood how to access relevant up to date government guidance and the procedures we saw staff following during the inspection were appropriate and reflected the latest guidance.

There were procedures in place to support safe visiting by people’s family members or professionals. Staff undertook screening of all visitors and rapid response lateral flow tests (LFT) were undertaken for visitors before they entered the home. Visitors were provided with Personal Protective Equipment (PPE) and guided to its safe use.

The home was kept clean. Staff kept records of their cleaning schedules, which included additional cleaning high touch surfaces, such as light switches and door handles. The home had communal areas providing space for people to socially distance.

People and staff were regularly tested for COVID-19. Staff completed an LFT test prior to each shift to ensure they were safe to support people. People were supported to have a test each month or undertake additional tests if required. Where necessary mental capacity legislation had been followed to ensure this was only done in people’s best interests. The registered manager understood the actions they needed to take should any tests return a positive result.

The service had a good supply of PPE to meet current and future demand. Staff were using this correctly and in accordance with current guidance and disposal was safe at the time of this inspection.

The provider had systems in place to support staff mental wellbeing.

Cherry Blossom Care Home is registered to provide accommodation for up to 35 older people with personal care needs, including people living with a cognitive impairment. There were 34 people living at the home at the time of the inspection.

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

People were supported by staff who showed kindness and respect towards them. They told us they felt safe and listened to living at Cherry Blossom Care Home.

Recruitment practices remained safe and there were sufficient numbers of staff available to meet people’s needs. People were protected from avoidable harm, received their medicines as prescribed and infection control risks were managed appropriately.

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 had received appropriate training and support to enable them to carry out their role safely. They received regular supervision to help develop their skills and support them in their role.

People were supported to access health and social care professionals if needed, received enough to eat and drink and were happy with the food provided.

Staff were kind, patient and responsive to people's needs and people were treated with dignity and respect. Staff’s knowledge of people’s history, preferences and risks associated with their care and support needs was good.

The management team were open and transparent. They understood their regulatory responsibilities. People and their relatives felt the management team were open, approachable and supportive. Everyone was confident the provider would take the necessary actions to address any concerns promptly. Feedback about the management team demonstrated they listened and took any feedback as an opportunity to make improvements for people.

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 June 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

There is no required follow up to this inspection. We will continue to monitor all information received about the service to understand any risks that may arise and to ensure the next inspection is scheduled accordingly.

Cherry Blossom Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service provides accommodation for up to 35 older people with personal care needs, including people living with a cognitive impairment. There were 33 people living at the home at the time of the inspection. All areas of the home were accessible via a lift and there were lounges/dining rooms on both floors. There was outdoor space available to people that could be accessed from the ground floor.

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.

At our last comprehensive inspection of the service on 25 May 2017, we had found a breach of Regulation 20 of the Health and Social Care 2008 Act (Regulated Activities) Regulations 2014. The provider had failed to act in an open and transparent way when people had been harmed. People or, where appropriate, their families had not been notified of the incidents that had occurred in writing, including a written apology, as required by the regulations. We had given the service an overall rating of ‘Requires Improvement’. Following the last inspection, the provider had sent us an action plan setting out the improvements they had intended to make.

At this inspection we recorded four breaches of Regulations in relation to Safe Care and Treatment, the Need for Consent, Person Centred Care and Good Governance, even though the provider had made some improvements to the service.

Consent to care was not always obtained in line with the Mental Capacity Act 2005. Some staff told us, they did not understand the Mental Capacity Act 2005 (MCA). This meant people's human rights were not fully protected.

Although regular audits were carried out to assess the quality of the service, these were not effective enough to identify the areas where improvements were needed. Some of the records were incomplete, inconsistent or out of date.

The ‘grab bag’ that was supposed to be used in case of evacuation from the building contained a list of the residents that was out of date. Some of the present residents were not on the list and the list contained a name of a resident who had passed away. The ‘grab bag’ first aid kit contained bandages that had expired in 2015.

Medicines were administered as prescribed, however, there were gaps in the records of application of topical creams.

We saw that some people used air mattresses that were set not accordingly to the weight recorded in their care plans.

People, their relatives and staff provided conflicting feedback about staffing levels.

There was no activities co-ordinator at the service. People’s social needs were met on a group level, however, the service was unable to meet individual social needs of people.

The laundry room appeared to need general maintenance and posed a risk in terms of infection control. On the second day of the inspection we saw evidence that the provider had obtained a quote needed for maintenance action which included all necessary work to remodel the laundry room.

Systems and processes for protecting people using the service from harm or the risk of harm occurring were in place and were clearly understood by staff. Staff demonstrated a good awareness of safeguarding procedures and knew whom to inform if they witnessed or had an allegation of abuse reported to them. Staff understood their responsibilities to report incidents that occurred in the service.

Recruitment practices ensured potential employees were suitable to work at the service.

People were provided with sufficient amounts of food and maintained a balanced diet to remain in good health. People had access to health care professionals when needed. The registered manager had worked hard to develop a good working relationship with the GP and district nurses.

Records showed staff received the training they needed to keep people safe and meet their needs. The manager had taken action to ensure staff training was kept up-to-date and future training was planned.

Staff told us they felt supported by the management and received supervision and appraisals, which helped to identify their training and development needs.

People were treated with dignity and respect. Staff recognised the importance of maintaining people's independence and did their best to do so. People were asked for their consent prior to any care task being delivered.

Relatives and people who used the service were provided with opportunities to share their views on the service, and complaints were managed in line with the provider's policy and procedures.

The service acted pro-actively, and they provided us immediately with an action plan to address the issues identified during the first day of the inspection.

You can see what action we told the provider to take at the back of the full version of the report.

There was a registered manager at the home. 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 and relatives were able to complain or raise issues on a formal and informal basis with the registered manager and were confident these would be resolved. However, the provider did not have a duty of candour policy in place to help ensure staff acted in an open way when people came to harm. Visitors were welcomed and there were good working relationships with external professionals.

There were systems in place to monitor the quality of the care provided and the safety of the environment. However, these were not always robust. For example, appropriate checks of lifting equipment had not been completed and medicine audits had not highlighted gaps in the Medicines Administration Record (MAR) chart or mitigated the risk of prescribed creams being used beyond their safe to use by date.

The risks relating to people’s health and welfare were assessed and these were recorded along with actions identified to reduce those risks. Risk assessments and care plans were personalised and provided sufficient information to allow staff to protect people whilst promoting their independence and choice.

Staff sought verbal consent from people before providing care. However, not all people’s ability to make decisions had been assessed in line with legislation designed to protect people’s rights.

People and their families told us they felt the home was safe. Most of the staff and the registered manager had received safeguarding training and all staff were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.

There were safe recruiting practices in place which ensured that all appropriate checks had been completed before staff started working at the home. Staff were well supported in their roles. However, not all staff had received appropriate or up to date training as required.

There were mixed views about the staffing levels in the home but people and their families felt that care needs were met. People had access to health professionals and other specialists if they needed them.

People were supported to have enough to eat and drink. People were given a choice about what they would like to eat and where food and fluid intake was reduced this was closely monitored and responded to appropriately. However, mealtimes were a rushed experience and a choice of drinks was not always provided.

Staff developed caring and positive relationships with people and were sensitive to their individual choices. They treated people with dignity and respect. People were encouraged to maintain relationships that were important to them.

There was an opportunity for people and their families to become involved in developing the service; they were encouraged to provide feedback on the service both informally and formally.

People and their families told us they felt the home was well-led and were positive about the provider who understood the responsibilities of their role. Staff were aware of the provider’s vision and values, how they related to their work and spoke positively about the culture and management of the home.

We identified one breach of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.

There was a registered manager at the home. 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.

There were enough staff to meet people's needs although staff were busy. Staff received appropriate training and were supported in their work. The recruitment process helped ensure staff were suitable for their role.

People felt safe and staff knew how to identify, prevent and report abuse. Legislation designed to protect people's legal rights was followed correctly. Staff offered people choices and respected their decisions. People were supported and encouraged to be as independent as possible and their dignity was promoted.

People, relatives and external health professionals were positive about the service people received. Medicines were managed safely and people received these as prescribed. People were positive about meals and the support they received to ensure they had a nutritious diet.

Care plans provided comprehensive information about how people wished to be cared for and staff were aware of people's individual care needs and preferences. Reviews of care involving people were conducted regularly. People had access to healthcare services and were referred to doctors and specialists when needed. At the end of their life people received appropriate care to have a comfortable, dignified and pain free death.

People and relatives were able to complain or raise issues on a formal and informal basis with the registered manager and were confident these would be resolved. This contributed to an open culture within the home. Visitors were welcomed and there were good working relationships with external professionals.

Staff worked well together, which created a relaxed atmosphere that was reflected in people's care. Plans were in place to deal with foreseeable emergencies and staff had received training to manage such situations safely.

The registered manager and provider were aware of key strengths and areas for development of the service. Quality assurance systems were in place using formal audits and through regular contact by the provider and registered manager with people, relatives and staff.

We spoke with four members of staff including housekeeping and care staff. Staff told us they had all received infection control training and had all the necessary equipment to reduce any risks of infection. The home was clean and there were systems in place to manage infection control risks.

There were also systems in place to monitor the quality of the service provided. These included audits completed by the manager and other staff. People's views were sought via meetings and relatives views during a survey completed in September 2013. These showed people were happy with the service provided.

We spoke with most staff on duty including cleaning staff and the manager. Staff were aware of how people should be supported, individual likes and dislikes and the help they required. Staff stated they felt they had sufficient time to meet people's needs and had attended relevant training. Staff were aware of safeguarding procedures.

We spent time observing care in communal areas and completed a Short Observation for Inspections tool (SOFI 2). We found people had positive experiences. We observed staff were courteous and respectful of people's views. Choices were offered and where necessary informal consent was obtained. The care we observed corresponded with care plans and risk assessments viewed.

There was a need to improve infection control procedures as people were at risk of cross infection. Staff were receiving training, support and supervision. The manager was implementing quality monitoring procedures and all necessary records were available and stored securely.

We viewed records of care, food and fluids that had been provided to people. We also viewed records of audits that were undertaken on these records and spoke with the registered manager and a senior staff member. We found that overall records were being maintained however there could be further improvements in the quality of record keeping. All records were stored securely.

There were 25 people living at the home at the time of our inspection and we spoke with 11 of them. We also spoke with three visitors and a healthcare professional who visited the home. This was in order to obtain their opinions about the service the home provided. We talked with five staff who worked at the home about the training and support they received. We asked them about the needs of the people living at the home.

People living at the home all expressed positive views about the staff working in the home and about the care, support and the food they received. Visitors we spoke with were also complimentary about the home. They described it as 'lovely' and 'brilliant'.

We observed staff working practices and saw that they understood the needs of the people they helped and treated them with dignity and respect.

We saw that there were systems in place that ensured; medication was managed safely; staff recruitment procedures were robust; the building was comfortable and safe; and people could express their views and influence the service the home provided.

We saw that records about people were not always kept securely or managed properly and we made a compliance action about this.