Cherry Leas Care Home

Cherry Leas Care Home is a residential care home providing personal care to up to 16 people. The service provides support to older people and people living with dementia. Cherry Leas Care Home accommodates 16 people in one adapted building. At the time of our inspection there were 9 people using the service.

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

The provider had initiated and implemented improvements since our last inspection. The provider had registered with the Care Quality Commission as manager of the service and was supported by a senior care worker who was taking over some management tasks. The provider had a strong focus on making improvements to the service and on creating a positive culture for the people who live there and the staff team.

The management of risks to people’s safety had improved. There were processes to identify risks and evidence action was taken to address these. Risks were monitored and assessments had been updated. There was a process in place to oversee incidents and accidents and to assess these for themes so action could be taken to mitigate further risk.

People were protected from the risk of abuse. The provider was aware of how to make statutory notifications to CQC and these had been made regarding serious injury to people who use the service and safeguarding referrals made to the local authority.

There were enough staff to support people to stay safe and meet their needs. Staff spoke positively about the improvements to the service and said they felt able to raise concerns.

People were supported by staff who knew them well and people’s relatives spoke positively about the care they received.

People received their medicines as prescribed. The provider had assessed staff competency to help ensure they understood how to support people appropriately with their medicines. 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.

The management of infection control processes had improved. The provider followed national guidance in relation to infection control. The premises at Cherry Leas Care Home were clean and hygienic and there were areas that had been refurbished.

The provider had improved the systems to assess the quality of the service provided, by introducing quality assurance processes to identify areas for improvement.

The provider and staff team had developed positive working relationships with external stakeholders and other healthcare professionals. There was clear evidence of the provider working in partnership to make improvements to the service.

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 inadequate (published 26 May 2022) and there were 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 the regulations.

This service has been in Special Measures since 26 May 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.

Why we inspected

We carried out an unannounced focused inspection of this service on 27 April 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Inadequate to Good. This is based on the findings at this 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cherry Leas Care Home on our website at www.cqc.org.uk.

Follow up

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

Cherry Leas is a residential care home providing accommodation and personal care to up to 16 people in one adapted building. The service provides support to older people and people living with dementia. At the time of our inspection there were 15 people living at the service.

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

The provider did not have sufficient oversight of the quality of the service or the risks to people’s safety. Risks were not always effectively monitored to ensure appropriate action was taken to keep people safe. Risks were not consistently identified, and risk assessments did not always contain up to date information. There was a lack of oversight of incidents and accidents which meant the provider was not able to demonstrate action taken to mitigate the risk.

The provider did not have effective systems and practices to safeguard people from the risk of abuse. There was not clear oversight to identify trends and prevent the risk of reoccurrence. Statutory notifications were not routinely made to CQC regarding safeguarding referrals and serious injury to people who used the service.

The provider did not have a clear system to learn from events and take appropriate action to improve safety. Not all staff members felt able to raise concerns.

The fire risk assessment did not appropriately identify all the risks to people who lived at the service.

The provider did not ensure support for staff was consistent and effective. Staff members told us they did not always feel able to be open when things went wrong, and they did not always feel they were treated equally.

People were supported by staff who knew them well and people’s relatives spoke positively about the care they received. However, there were not enough staff to support people to stay safe and meet their needs.

People received their medication as prescribed. The provider had assessed staff competency to help ensure they understood how to support people appropriately with their medicines. However, not all records were maintained in line with national guidelines.

The provider did not follow or meet national guidance in relation to infection control. The premises at Cherry Leas Care Home were not clean and hygienic, which put people at risk of infection.

The provider did not have embedded systems for good quality assurance. The service was not proactively using systems to identify areas for improvement. Where concerns had been identified appropriate action had not been taken to address the issues raised.

The provider did not always ensure collaboration with external stakeholders. There was little evidence of working in partnership to make improvements to the service.

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 this service was good (published 10 January 2018).

Why we inspected

We received concerns in relation to the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from Good to Inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

Enforcement

We have identified breaches in relation to safe care and treatment, governance, staffing and failure to notify CQC of other incidents at this inspection.

Please see the action we have told the provider to take at the end of this report.

The provider responded promptly to the concerns raised during the inspection, sending a comprehensive action plan detailing the action to be taken to reduce the level of risk.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cherry Leas Care Home on our website at www.cqc.org.uk.

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 6 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.

The home had a registered manager in post. 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 and associated Regulations about how the service is run.

People appeared happy and relaxed with staff. There were sufficient staff to support them. When staff were recruited, their employment history was checked, references obtained and comprehensive induction completed. Checks were also undertaken to ensure new staff were safe to work within the care sector.

Staff were knowledgeable and trained in safeguarding and knew what action they should take if they suspected abuse was taking place. Appropriate training was provided to ensure staff were confident to meet people's support needs.

It was evident staff and the registered manager had spent considerable time with people, getting to know them, gaining an understanding of their personal history and building rapport with them. People were provided with a choice of healthy food and drink ensuring their nutritional needs were met.

People's needs had been assessed and detailed care plans developed. Care plans contained risk assessments for a wide range of daily living needs. For example, nutrition, falls, and skin pressure areas. People consistently received the care they required, and staff members were clear on people's individual needs.

Care was provided with kindness and compassion. Staff members were responsive to people's changing needs. People's health and wellbeing was carefully monitored and staff regularly liaised with healthcare professionals for advice and guidance.

Medicines were managed safely in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

Where people lacked the mental capacity to make specific decisions the service was guided by the principles of the Mental Capacity Act 2005 (MCA). Where appropriate 'best interests' meetings had been instigated and outcomes recorded.

People were provided with opportunities to take part in activities 'in-house' and to access the local and wider community. People were supported to take an active role in decision making regarding their own daily routines and the general flow of their home.

Staff had a clear understanding of the vision and philosophy of the home and they spoke positively about their work and the management. The provider had established systems in place and the registered manager undertook regular quality assurance reviews to monitor the standard of the service and drive improvement.

The service had a registered manager in post. 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 and associated Regulations about how the service is run.

People who lived at the home, relatives and staff told us people were safe. There were systems in place to protect people from the risk of harm. These included comprehensive staff recruitment and training practices. Procedures were in place to effectively protect people against risks of abuse.

The provider had a robust recruitment process in place. Records we looked at confirmed that staff were only employed within the home after all essential safety checks had been satisfactorily completed.

The CQC monitors the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) which applies to care services. We saw that there were policies and procedures in relation to the MCA and DoLS to ensure that people who could not make decisions for themselves were protected. We saw that staff had followed guidance and were knowledgeable about submitting applications to the appropriate external agencies. Records viewed showed us that where people lacked the capacity to make decisions they were supported to make decisions that were in their best interests. People were only deprived of their liberty where this was lawful and there was no one subject to a DoLs at the time of our inspection.

There was a process in place to ensure that people’s health care needs were assessed. This helped ensure that care was planned and delivered to meet people’s needs safely and effectively. Staff knew people’s needs well and how to meet these. People were provided with sufficient quantities to eat and drink.

People’s privacy and dignity was respected at all times. Staff were seen to knock on the person’s bedroom door and waiting for a response before entering and by using suitable means to protect people’s dignity when providing personal care.

Care records we viewed showed us that wherever possible people were offered a variety of chosen social activities and interests. People were supported in a way that helped prevent social isolation for them.

The provider had an effective complaints process in place which was accessible to people, relatives and others who used or visited the service.

Checks had been completed for things such as lifting equipment and gas and electrical safety in the home. This ensured that the home was a safe place for people, staff and visitors.

The provider had effective quality assurance systems in place to identify areas for improvement and appropriate action to address any identified concerns. Audits, completed by the provider and registered manager and subsequent actions taken, helped drive improvements in the service.

Is the service safe?

Staff had received a range of training to protect people from harm. Safeguarding of vulnerable adults from abuse (SOVA), Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) training were completed every year. Staff we spoke with told us that they were aware of the action they would take if they suspected abuse was or had taken place. They were also aware of what it meant to deprive someone of their liberty and why this was sometimes necessary.

We found that the service had suitable arrangements in place to gain people's consent to and assess people's mental capacity to make decisions should they not be able to consent to their care.

The policy, procedures and quality monitoring of the service included health and safety and reviews of care planning and delivery. This system was comprehensive and ensured people lived in a safe environment with safe care.

Is the service effective?

People were satisfied with the care and support they received. This was consistent with the positive feedback received from people as reported in the provider's own quality assurance survey. All of the staff we spoke with were knowledgeable about individual people's care needs, and this knowledge was consistent with the care plans in place.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. People commented, 'I never feel rushed by the staff that help me, they don't do everything for me and help me to do things for myself." We spoke with three people who used the service. One person said to us, "I am very happy here. Everyone is very kind." Another person said, "The staff are very helpful and this is a beautiful place to live." We observed the care and attention people received from staff. All interactions we saw were appropriate, respectful and friendly and there was a relaxed atmosphere throughout the home.

Is the service responsive?

We saw that care plans and risk assessments were informative, up to date and regularly reviewed. The registered manager responded in an open, thorough and timely manner to complaints. This meant that people could be assured that complaints were investigated and action was taken as necessary. Staff told us the manager was approachable and they would have no difficulty speaking to them if they had any concerns about the home.

Is the service well led?

Staff said that they felt well supported by the manager, there was a positive sense of the team working together and they were able do their jobs safely. The provider had a range of quality monitoring systems in place to ensure that care was being delivered appropriately by staff.

We saw that staff were knowledgeable about the needs of people living in the home, treated them with respect and provided care in ways that people preferred and that met their needs.

During our inspection we saw that people received good care. Relatives who had sent letters and cards of thanks to the home spoke about their gratitude for the good care provided.

People were happy with the quality of the home cooked food and we saw that there was a relaxed and sociable atmosphere when people were having lunch.

During our visit we spoke with people who told us they liked living at Cherry Leas. We saw that people smiled and appeared relaxed and comfortable with staff and others living in the home.

During our inspection we saw that people received good care. A relative spoken with was also complimentary about the standard of care their relative received.

One person living in the home told us they liked the food at Cherry Leas and someone else said the home was lovely.