Cherry Tree Cottage

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.

This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

The service did not make sure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them.

The service had an admissions policy. However, there was no clear inclusion or exclusion criteria for the service. Therefore, there was no clear guidance to determine the appropriateness of a client for the service. The policy noted it would consider factors such as physical and mental health, prescribed medication and history of self-harm and suicide attempts. It also listed factors such as ability to consent, willingness to engage and criminal convictions for arson, sexual offences or serious violence. We were told by the newly appointed registered manager that the final decision around suitability of clients and admission sits with them and the doctor and is decided on an individual basis.

All client records were handwritten and in paper form. Staff did not always fully complete pre-admission paperwork efficiently. Staff did not provide individual care plans in line with their policy. All clients had a management plan after their medical assessment; however, these were all worded the same, and we did not see evidence of consideration for their individual risks.

A client record noted that they had early liver damage in their previous blood test, and they had a liver scan booked for 2 days after detox had commenced. This meant a full assessment of liver function had not taken place prior to commencing detox. This client did not have a fully completed alcohol intake assessment or suicide risk screening prior to detox commencing. They had also not completed the National Drug Treatment Monitoring System (NDTMS) Treatment Outcomes Profile (TOP) form that should be completed to pre and post detox. The doctor assessed previous/current symptoms relating to liver failure, however, the management plan for this client did not acknowledge or mention signs or symptoms to observe for deterioration in the future. This client was also noted to have an elevated blood pressure. The alcohol withdrawal scale that was being completed daily included taking blood pressure. However, in the doctors’ management plan, there was no acknowledgement of elevated blood pressure, or reference to escalation processes or treatment plans. This meant it may not be clear to recovery workers that they needed to monitor this more closely and how to escalate concerns where appropriate. This client’s pre-admission paperwork noted history of acid reflux and stomach ulcers, and their abdomen was noted as bloated. The implications of a detox on these physical health issues were not documented in the medical assessment and management plan.

Another client had attempted suicide by overdose on 2 occasions within 2 months prior to admission. Their part 1 pre-admission paperwork was incomplete as it referred to this but did not elaborate in the suicide and self-harm risk screening section of the assessment, which was blank. This was discussed in the doctors’ assessment; however, the management plan wording was the same as the other clients’ who had not had this history, which was a brief sentence around informing staff if they are suicidal/anxious. This meant management plans lacked personalisation and were generic, not acknowledging each clients’ individual risks and mitigations/plans to manage these.

We saw that all clients had been asked around their history of Blood Borne Viruses (BBVs). However, the care records were not always completed in full and the date and results of BBV previous or current testing were not completed. It was not evident within care records and medical assessments that clients were offered testing and referral for BBV testing, in line with national guidance.

Since the inspection, we have seen evidence of communication between the doctor and the recovery workers regarding 3 potential new admissions. GP summaries were requested for all of these, and decisions were made based on this information. We saw that 1 person was not deemed suitable for the service due to risks associated with suicidality, level of alcohol intake and history of seizures. The provider also acknowledged the inconsistencies regarding the completion of pre-admission paperwork and told us they were working together to streamline the document and intended to provide training to staff to ensure consistency.

The service did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.

Current guidance in line with the National Institute for Clinical Excellence (NICE) highlight the importance of using dependency and withdrawal scales, which were not always used in pre-admission assessments. Physical health and mental health assessments were not always completed sufficiently in line with best practice guidance. Detoxes were commenced without the gathering of GP summaries prior, contrary to NICE guidance.

Staff were not adequately equipped with supervision and training to support client detoxes in line with NICE and Department of Health and Social Care guidance.

The service operated under a 12-step programme. The service offered groups to clients relevant to their needs, including groups about alcohol and drugs, the 5 rules of recovery, triggers, co-dependency and denial. The service had a counsellor who provided various therapies such as Cognitive Behavioural Therapy (CBT) and art therapy.

Staff had weekly meetings with a set agenda. We saw an example of how a staff member was placed on a development plan to support them due to their performance.

The service did not work well across teams and services to support people. They did not share their assessment of people’s needs when moving between different services.

We were told staff completed verbal handovers at multiple intervals throughout the day, but there was no documentation of these. We did not observe a handover, or review any recorded handovers, therefore we were not assured effective handovers were taking place. However, each client record had daily progress notes that were completed, meaning these could be sourced and reviewed if required. We were informed that when handovers do not take place or were not documented, staff are required to sign client notes to confirm they have read them. The provider acknowledged an over-reliance on verbal handovers in their own post-inspection audit and intended to address this to improve client care.

Team meetings took place on a weekly basis. Minutes were taken and shared with the team via email. This included agenda items such as client review, aftercare, counselling and any other business.

There were no clinical governance meetings happening at the time of the inspection. This meant a lack of multidisciplinary team (MDT) discussion around clients. Given that the provider is a standalone service with limited clinical oversight, there were concerns around the lack of MDT working. This was also acknowledged in their internal audit, and the service told us they planned to re-introduce clinical governance meetings at a 2 monthly frequency. We saw evidence that a clinical governance meeting took place after the inspection with an intention to plan another for the following month.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff supported clients to live healthier lives. The timetable for clients included regular use of a local gym. They also completed groups to promote sustained abstinence from substances to reduce their need for future support. The provider also offered meditation groups to help clients maximise their wellbeing.

The service employed a chef to ensure adequate dietary intake. We saw that the service supported people to maximise their wellbeing, independence, choice and control. We saw fruit available for clients to access whenever they wanted it. Clients could purchase their own snacks and eat these when they wanted. Clients could make their own drinks as they wished.

Clients that were detoxing from alcohol had daily physical health monitoring as part of their treatment.

We were not assured that staff were testing for BBVs.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff tracked clients throughout their treatment until completion between August 2025 and February 2026 on a spreadsheet. Of these, 37 out of 43 clients successfully completed treatment; there were 6 early discharges from treatment, and 9 clients extended their treatment. Treatment Outcome Profiles (TOP) forms are recommended by Public Health England before and after substance misuse treatment as part of the National Drug Treatment Monitoring System to monitor outcomes. However, we could not see evidence of these being completed.

Staff maintained contact with clients through an aftercare programme that consisted of wellbeing checks for 3 months post completion of treatment to monitor their progress, with their consent. These were handwritten and kept in their client record files. However, the provider did not maintain any data on long-term outcomes of clients.

We were told by carers of clients that the clients returned to the service after completing treatment as part of aftercare to attend groups such as art, and that clients kept in touch outside of the service as friends.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Clients signed a treatment contract on admission to the unit and again within the first 48 hours of treatment in line with policy.

Clients signed consent forms to confirm they gave permission for their GP records to be shared with the service to enable a fully comprehensive assessment.

Consent protocol noted that if a client was not deemed to have capacity due to intoxication, the reviewing of consent to share information and admission could be reviewed within 24 hours. We reviewed one client record where a client was intoxicated on admission and their risk assessment identified they lacked capacity. Their family member signed a treatment payment contract on the day of admission, and it was documented that the client signed a treatment contract on the day of admission. It is not clear whether the decision to begin detox was a fully informed decision by the client due to being intoxicated at the time and concerns around capacity were noted. However, the client did re-sign the contract 24 hours later.