Cherry Tree

About the service

Cherry Tree is a residential care home providing accommodation and personal care for up to seven people with learning disabilities, autistic people and people with mental health and physical health needs. At the time of this inspection six people were living at the service. People living in the home had their own bedrooms and there were shared communal spaces, including lounges, a kitchen and a garden area, all on one floor.

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

We found improvements had been made in the service following our last inspection.

Right support

The provider had made improvements following our previous inspection, to make the home safer. Systems were in place to protect people from the risk of abuse. Risks to people’s health were assessed so staff could support them safely. People’s medicines were managed safely but staff did not always record the temperature of refrigerators, which stored some medicines. The provider told us they would follow this up. Staff were recruited appropriately to ensure they were suitable to work with people. Staffing numbers in the home were sufficient so people could be supported and their needs met. Systems were in place to prevent and control infections. Lessons were learned following accidents and incidents in the home. People had control of how their care and support was arranged. People were supported to go out and visit the local community.

Right care:

Processes to assess people’s needs to determine if the home was suitable for them were in place. People received care and support that was personalised for their needs. Staff were trained to carry out their roles and received support with their development. People attended health appointments with professionals to help maintain their health. They were supported to maintain a balanced diet and their nutritional and cultural needs were met. 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.

Right culture:

The values and attitudes of staff and managers in the home enabled people to be as independent as possible, feel empowered in their daily lives and achieve positive outcomes. Managers took action to ensure staff understood their professional responsibilities to support people in the right way. The management team learned lessons when things went wrong in the home. However, people’s dignity, privacy and human rights were not always respected. We discussed this with the manager as part of ongoing improvement actions. We have also made a further recommendation for the provider to follow best practice with using effective communication tools for people.

People were supported to follow their interests inside and outside of the home. For example, we saw people go out to a day centre and take part in their preferred activities. Systems were in place to manage and respond to complaints. Feedback was sought from people and relatives to help make continuous improvements to the home.

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

Rating at last inspection

The last rating for the service was Inadequate, (published on 24 May 2022) and there were multiple breaches of regulations. We issued warning notices to the provider for breaches of Regulation 12 (Safe care and treatment), Regulation 17 (Good governance) and Regulation 18 (Staffing).

We issued requirement notices to the provider for breaches of Regulation 9 (Person-centred care), Regulation 10 (Dignity and respect), Regulation 11 (Need for consent), Regulation 14 (Meeting nutritional and hydration needs) and Regulation 15 (Premises and equipment).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

This service has been in Special Measures since 29 June 2022. 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 and no longer in breach of regulations.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cherry Tree 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.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Cherry Tree is a residential care home providing accommodation personal care for up to seven people living with diagnosis including mental, physical health and learning disability needs. At the time of this inspection seven people were living at the service. People living in the home have their own bedrooms and there are shared communal spaces, including lounges, a kitchen and a garden area. The building is one floor.

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

The systems in place to audit the quality of the service were not robust or sufficient to alert the provider of the concerns and issues within the service. Audits had not picked up areas which were identified during the inspection. People were at risk because the provider had not acted to ensure they had sufficient oversight of the service. Records were an area of concern across the service; records were not complete and accurate.

Risks associated with people accessing transportation, walking around the home with their bare feet and allergic reaction of eating had not been robustly assessed and action had not been taken to reduce risks to keep people safe.

Medicines were not managed safely. Policies and processes for managing medicines were not always followed. Controlled drugs (CD) prescribed for people were not being recorded in the medicines administration records (MARs). People did not always get their medicines as prescribed. We did not see any evidence that people who administers medicines had undergone appropriate training and competency assessment were not routinely carried out.

People's care plans contained conflicting and confusing information about their mental capacity. It was not always clear when a person lacked capacity and when a best interest’s decision had been made, who had been involved in the decision making process.

Maintenance tasks had not always taken place in a timely manner, which could put people at risk of harm. We observed the garden was not being maintained as there was overgrown stinging nettles and weeds which could potentially be a hazard for people. After the inspection, the provider sent a photo of the garden being maintained.

There was a lack of provider and managerial oversight of the service. There was a failure by the provider to ensure robust governance arrangements were in place to monitor the safety and quality of the service. Shortfalls across the service such as poor risk management, lack of oversight of medicines and limited oversight of people mental capacity had not been identified prior to our inspection.

Confidentiality of people's personal information was maintained. Staff were aware of their roles and responsibilities and felt supported by the management team. Staff followed infection control procedures and people were protected from the risk of infections such as COVID-19. Staff were safely recruited. People and relatives told us staff were caring and they were treated with respect.

Right Support

The service did not always support people to have the maximum possible choice, control and independence over their own lives. Due to lack of staffing and more recently, a lack of experienced staff, the person's choices, control and independence were not maximised. They were regularly unable to take part in activities. Staff shortages had impacted on the ability of people to access activities of their choice. One staff told us, “We can’t take them [people] out as we don’t have enough staff.” Records confirmed people did not always receive support from staff to pursue their interests due to availability of staff.

Right Care

Staff failed to protect and respect people’s privacy and dignity. During our inspection we saw people were not always treated in a dignified manner by staff. Staff had training on choking, however, we could not be assured this was effective. People were at risk of not receiving their medicines when needed and recording systems were not always in place or guidance for as required medicines. Staff did not always have the relevant skills or experience to ensure they received the appropriate care.

People who had individual ways of communicating, using body language, sounds, Makaton (a form of sign language), PECS (The Picture Exchange Communication System) pictures and symbols could not interact comfortably with staff and others involved in their care and support because not all staff had the necessary skills to understand them. One staff told us, “We need training in Makaton and PECs so we could communicate with them [people].”

Right culture

People failed to receive good quality care, support and treatment because staff could not always meet their needs and wishes. Staffing levels were reported to be consistently below the number required to meet people's needs and to keep people safe. The provider had not established, or implemented, appropriate staffing levels that either ensured people were safe, or that they received the care they needed. The providers monitoring and oversight processes was not effective and had not identified the substantial shortfalls being identified

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

This service was registered with us on 05 March 2021 and this is the first inspection. The last rating for this service under the previous provider, Care Management Group Limited was Good.

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture.

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.

This service had not previously been inspected and we wanted to check that people were receiving safe care and support.

Enforcement

We have identified breaches in relations to safe care and treatment, good governance, staffing, need for consent, person-centred care, privacy and dignity, meeting nutritional and hydration needs, and, premises and maintenance.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 six 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.