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Inspection carried out on 4 December 2018

During a routine inspection

This inspection took place on 4 and 17 December 2018. The first day of the inspection was unannounced. This meant the staff and provider did not know we would be visiting.

This service is a domiciliary care agency. It provides personal care to older people living in their own flats within the Cherry Tree Gardens complex.

Not everyone living at Cherry Tree Gardens received the regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. On the day of our inspection there were 34 people receiving personal care at the service.

The service had a registered manager in place. A registered manager is a person who has registered with CQC to manage the service. Like 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.

Cherry Tree Gardens was last inspected by CQC on 13 September 2017 and was rated requires improvement. At the inspection in September 2017 we identified the following breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance).

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the five key questions to at least good. At this inspection we found improvements had been made in all the areas identified at the previous inspection.

Medicines were safely administered and procedures were in place to ensure people received medicines as prescribed.

Accidents and incidents were appropriately recorded and investigated. Risk assessments were in place for people and described potential risks and the safeguards in place to mitigate these risks. Management and staff understood their responsibilities with regard to safeguarding and had been trained in safeguarding vulnerable adults.

There were enough staff on duty to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff. Staff were supported in their role via appropriate training and regular supervisions.

People were supported to have maximum choice and control of their lives, and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of people being supported during visits to and from external health care specialists.

People and family members were complimentary about the standard of care at Cherry Tree Gardens. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

People’s needs were assessed before they started using the service and support plans were written in a person-centred way. Person-centred means ensuring the person is at the centre of any care or support and their individual wishes, needs and choices were considered.

Activities were arranged for people based on their likes and interests, and to help meet their social needs. The service had good links with the local community.

People and family members were aware of how to make a complaint. The provider had an effective quality assurance process in place. People, family members and staff were regularly consulted about the quality of the service via meetings and surveys.

Inspection carried out on 30 August 2017

During a routine inspection

This unannounced inspection took place on 30 August and 4 and 13 September 2017.

Cherry Tree Gardens provides a personal care and support service to people living in their own flats and bungalows within purpose built accommodation run by an external housing provider. There are 40 apartments and seven bungalows on site. The service is known as an “Extra Care” service and provides on-site support seven days per week and 24 hours per day including the use of a community alarm.

At the last inspection in 2016 we found the provider had breached Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the registered provider did not have accurate records to support and evidence the safe administration of medicines. The provider did not have effective quality assurance processes to monitor the quality and safety of the service provided, and to ensure that people received appropriate care and support. We asked the provider to take action to make improvements. The provider agreed they would be compliant with the regulations by 31 December 2017. During this inspection we found some improvements had been made. However we found further breaches of Regulations 12 and 17.

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.

Pre-employment checks were carried out by the provider before staff started working in the service. Staff who were new to the service completed an induction, and were then supported through training, supervision and appraisals.

The service met the requirements of the Mental Capacity Act. Staff had been trained in the legislative requirements. We found consent had been obtained from people to enter their accommodation in the case of an emergency. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

We found some of the people who used the service had complex health needs. Care plans were not in place to ensure people with complex needs received appropriate care. Staff were not always able to tell us about people’s conditions.

Staff had conducted an assessment of people’s needs. However we found where people had specific needs care plans had not been put in place to guide staff on how to meet those needs. This meant people were put at risk of receiving inappropriate care.

Records in the service were found to require updating to ensure they were accurate and all relevant information about people’s care needs was available to staff.

Staff had recorded accidents in the service. We found these had been monitored by the manager to prevent reoccurrences.

People we spoke with during the inspection gave us mixed views about the standards of care they received. Whilst some people were complimentary about the care they received from staff, others said the standards of care could be improved.

The provider had introduced quality audits to the service. We saw the audits were being carried out and resulted in actions plans with deadlines to make improvements.

Partnership working arrangements were in place between the housing provider and the service.

The provider had in place a complaints policy. We found complaints irrespective of their seriousness were documented in different ways according to how they were received. We have made a recommendation about this.

During our inspection we found two of breaches of 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.

Inspection carried out on 22 June 2016

During a routine inspection

The inspection took place on 22 and 23 June 2016. This was an announced inspection.

Cherry Tree Gardens is a domiciliary care service which provides personal care and support with domestic tasks to people living in an extra care scheme. At the time of this inspection 32 people were using the service.

Care is provided 24 hours a day seven days a week by on site care staff and an emergency call facility. Additional services provided included a bistro, hairdressing salon and organised social activities. The provider is an employee owned social enterprise. The premises are maintained by a housing provider which is a charitable community benefit society.

The service 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.

We found the provider had breached Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the registered provider did not have accurate records to support and evidence the safe administration of medicines. The provider did not have effective quality assurance processes to monitor the quality and safety of the service provided, and to ensure that people received appropriate care and support.

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

We have made a recommendation about care plans.

People told us they felt safe at Cherry Tree Gardens. One person said, “I came here three years ago and it’s the best thing I’ve ever done in my whole life. I feel very safe here.” Another person told us, “Carers are always on hand so that makes me feel safe.”

Staff completed safeguarding training as part of their induction, and this was updated regularly. Staff knew how to report concerns and were able to describe different types of abuse. Staff said they had confidence in the care manager to investigate such concerns thoroughly.

A range of risk assessments had been carried out to help keep people safe. These included assessments of the person’s home environment. Accidents and incidents were recorded in people’s care plans.

Staff completed an induction programme and shadowed more experienced staff before providing care to people on their own. Staff told us they had received enough training for their job role and they felt supported.

People were happy with the care and support they received and spoke positively about the staff. A person said, “The carers are fantastic here. I can’t fault the staff.” A relative told us, “The staff are kind and courteous but they have a laugh and a joke with [family member] as well.”

Each person who used the service had a copy of the ‘service user information guide’ in their care records which were kept in people’s apartments. The information guide contained information about all aspects of the service, including how to make a complaint, how to report safeguarding concerns and how to access independent advice and assistance such as an advocate.

People and relatives knew how to make a complaint. Where complaints had been made these had been dealt with to people’s satisfaction within the timescales in the provider’s policy.

Feedback was sought from people and their relatives every six months. In a recent quality survey 92% of people who responded were ‘very satisfied with the provider.’

Staff described the care manager as approachable and helpful. Staff said they didn’t see much of the registered manager. Some people and staff told us they didn’t know who the registered manager was.

Inspection carried out on 18 November 2013

During a routine inspection

During the inspection we were able to observe the experiences of the people who used the service. We found that there were thirty-six people who used the service. We also spoke with people who used the service and their relatives. The comments were very positive. One person told us, “I am very, very happy with the service. The staff are very helpful. I am happy with the care I receive”. Another told us, “It is very good here, and I get support with dressing and bathing. I have just got to ask and the staff will help, they are very helpful”. A third person said, “I can ask about anything here, they are flexible. I feel very safe”. We spoke with the six staff on duty and the manager. Staff told us they were well supported in their work.

We were able to observe the experiences of people who used the service. We saw that staff treated people with dignity and respect. We saw that as they responded to any calls for assistance they spoke to people with courtesy and respect. We saw that they rang the bell and knocked on the doors of people’s flats before they entered. In cases where people had their doors open staff would ask for permission before they entered. One person told us, “The staff help me to get dressed, they always make sure I have clean clothes. They are lovely”. Another told us that, “I have my own flat; if I need any extra help I press my pendant and then some staff will come”.

We saw that the people using the service related well with the staff. We saw that the staff communicated well and appropriately with people, addressing them by the title of their choosing. The relatives we spoke to were positive about the care received by their relatives. One relative told us, “The care is very good; I can also talk to the manager if I have any concerns.” People who used the service also told us that they felt safe in their homes. They described the arrangements for entering the scheme and their own personal arrangements for their flats. One person told us, “The outside door to the building is locked after six o’clock at night. I can lock my flat door anytime and I feel safe here”.

We saw that the scheme had a number of communal lounges where activities took take place and there was also a dining area with a café. People told us that a hairdresser, massage therapist and chiropodist often visited the home, and we saw the treatment room. We saw that staff were attentive and interacted well with people. People told us that they liked to make choices. On the day of the inspection we saw people had been supported to the communal dining room if they so desired.

In order to determine how care and treatment was provided we spoke with staff, observed their practices and looked at the records of ten people who used the service.

The manager had carried out a survey of each person who used the service. In the survey the people that used the service said that the care at the home was very good and that they service felt safe.

We found that people were involved in their care and were treated with respect.

We found that people who used the service had their care and welfare needs met.

We found that staff were supported in their roles and had received training and guidance in supporting people. We found that people were safeguarded against abuse.

We found that staff had been well supported to deliver care and treatment safely.

We found that people’s views were important and listened to. We found that there was an effective complaints system in place.